GHP Family Provider Manual - Geisinger Health Plan

the affected party.P. Waiver. Failure of a party to complain of any act or omission on the part of another party shall not be deemed to bea waiver. No waiver by a party of a breach of the Agreement will be deemed a waiver of any subsequent breach.Acceptance of partial payment will be deemed a part payment on account and will not constitute an accord andsatisfaction.PRIMARY CARE PROVIDERS (PCP)A Primary Care Practitioner (PCP) is a specific physician, physician group or a Certified Registered Nurse Practitioner(CRNP) operating under the scope of his/her licensure, and who is responsible for supervising, prescribing, and providingprimary care services; locating, coordinating and monitoring other medical care and rehabilitative services andmaintaining continuity of care on behalf of the Member. Additional PCP responsibilities include, but are not limited to:• Providing primary and preventive care and acting as the Member’s advocate, providing, recommending andarranging for care.• Documenting all care rendered in a complete and accurate encounter record that meets or exceeds the DPWdata specifications.• Maintaining continuity of each Member’s health care.• Communicating effectively with the Member by using sign language interpreters for those who are deaf or hardof hearing and oral interpreters for those individuals with LEP when needed by the Member. Services must befree of charge to the Member.• PCPs are responsible for initiating and coordinating referrals of Members for Medically Necessary servicesbeyond the scope of their contract of practice. PCPs must monitor the progress of the referred Members’ care.• Maintaining a current medical record for the Member, including documentation, of all the services provided tothe Member by the PCP, as well as any specialty or referral services.• Arranging for Medically Necessary Behavioral Health Services for Members by appropriate referrals to aHealthChoices Behavioral Health – Managed Care Organization (BH-MCO) in accordance with thespecifications of the provider agreement.MEMBER ASSIGNMENT TO PCPUpon enrollment, Members may choose a PCP for themselves and any other eligible family Members. Any Memberwho does not select a PCP within fourteen (14) Business Days of enrollment will automatically be assigned to a PCP.If the Member is dissatisfied with the auto-selection assignment, or wishes to change their PCP for any other reason, theMember may choose an alternative PCP at any time by calling Customer Service. GHP Family will promptly grant therequest and process the PCP change in a timely manner.GHP Family manages each PCP’s panel to automatically stop accepting new Members after the limit of 1,000 Membershas been reached. Upon contracting with GHP Family, if the PCP/PCP Site employs Certified Registered NursePractitioners/Physician Assistants, then the Provider/Provider Site will be permitted to add an additional 1,000Members to the practice’s panel. Other exceptions to the 1,000 Member panel policy will be considered on a case bycase basis. Please contact your GHP Family Provider Relations Representative for more information.15