Provider Procedural Manual - The Health Plan

PROVIDER PROCEDURAL MANUAL 2014PRIMARY CARE PHYSICIAN GUIDELINES1. You will be listed on The Health Plan Provider Directory under Primary Care Physicians(MEMBERS MUST SELECT A PRIMARY CARE PHYSICIAN).2. If you have a medical subspecialty, you may also be listed under a second category foryour specialty.3. If you wish to change to a different category on the Provider Lists, you must make a requestin writing to Provider Relations.4. If you wish to be listed as NOT ACCEPTING NEW PATIENTS on the Provider Lists,you must meet the required minimum and make a written request to Provider Relations.5. PATIENT ROSTER:a. Primary Care Physician Patient Roster can be obtained through our Provider SecureWebsite that enables your office to generate a member Roster at any time. The memberinformation is updated every 24 hours / 7 days per week. To access The Health Plan’sProvider Website, simply click on www.healthplan.org. Be sure to cross-reference themember I.D. number, date of birth, and name that appears on your Roster with theinformation in your member's chart to ensure that they are the same people.Please refer to Obtain a Member Roster, Electronic Communications Section of theProvider Web Site, for step-by-step instructions on how to obtain your member roster.b. You will only have access to see those patients who have you listed as their PrimaryCare Physician.c. Once you have obtained your Roster, it should be checked for patients who may belisted, but have never been seen and patients who are seen regularly but do not appearon the Roster.d. The Roster should also be checked before patient appointments.e. If you wish for the member to choose you as his/her Primary Care Physician,you may have the member call The Health Plan from your office. Members maychange their Primary Care Physician once per month by calling the following:The Health Plan Customer Service DepartmentOhio Valley and Mountaineer Region: (740) 695-7902 or (800) 624-6961HomeTown Region: (888) 830-4370 or (330) 830-4370Section 2 / Page 6