SHP - what are Primary Care Physician (PCP) Responsibilities ?

Primary Care Physician (PCP) Responsibilities

The following is a summary of responsibilities that are required of PCP’s providing services to Simply Healthcare Plans members:

* Ensure 24/7/365 availability as outlined in the Access to Care section noted above

* Identify, coordinate, and supervise the delivery and transition of care needs/services to each SHP member

* Ensure newly enrolled members receive an initial office visit and health assessment within ninety (90) days of enrollment in the Plan and assignment to the PCP

* Maintain a ratio of members to full-time equivalent (FTE) health care providers, as follows:
 One (1) FTE physician per 1,500 SimplyCaid members
 One (1) Advanced Registered Nurse Practitioner (ARNP) or Physician Assistant
(PA) for every 750 SimplyCaid members above 1,500 members

* Ensure members utilize Plan participating network providers. If unable to locate a participating provider for services required, contact Utilization Management for assistance.

* Provide preventative healthcare screening services, as per nationally recognized guidelines/protocols – see links in Section 8 of this Handbook

* Have a procedure for non-compliant members: documentation and verbal or written notification to the member

* Provide regular appointments for adult healthcare, assessments and treatment, as indicated, or upon request for those members twenty-one (21) years of age and older

* Perform physical examinations within 72 hours or immediately if required for children taken into protective custody, emergency shelter or into the foster care program by the Department of Children and Families (DCF)

* Provide Child Health Check-Ups (CHCUP) as per the approved guidelines (Refer to CHCUP section below)

* Provide immunizations as per the approved guidelines

* Participate in the Vaccines for Children (VFC) program for members eighteen (18) years of age and younger (Refer to Children’s Vaccines section below)

* Providers will administer only VFC-supplied vaccinations for all members eighteen (18) years of age and younger that are supplied free to the provider through the VFC Program

* Provide immunization information to the Department of Children and Families (DCF) upon receipt of the member’s written permission and DCF’s request, for members requesting temporary cash assistance from the DCF

* Ensure members are aware of the availability of medical non-emergency transportation and/or public transportation, where available, by contacting Member Services for assistance

* Ensure translation services are available for those members requiring translation needs, including members requiring services for the deaf, by contacting Member Services for assistance

* Ensure members are aware of available community services/resources that are available to the member by contacting Member Services or a Care Manager

* Provide access to the Plan or its designee to examine thoroughly the Primary Care offices, books, records, and operations of any related organization or entity.

* Provide access to the Plan or its designee to conduct medical record audits, as per regulatory requirements or indicated

* Submit an encounter for each visit where the provider sees the member or the member receives a HEDIS® (Health Care Effectiveness Data and Information Set) service

* Submit encounters on a CMS 1500 Form