GHP Family Provider Manual - Geisinger Health Plan

• A designated SCP to provide and coordinate both primary and specialty care for the Member. The SCP treatingthe Member’s disease or condition will serve as the Member’s PCP, coordinating care and making referrals toother SCPs, as needed.Please refer to Medical Management & Prior Authorizations section of Manual for more information.SCP AS PCPA Member may qualify to select a SCP to act as PCP if she/he has a disease or condition that is life threatening,degenerative, or disabling The SCP as a PCP must agree to provide or arrange for all primary care, consistent with GHPFamily preventive care guidelines, including routine preventive care, and to provide those specialty health care servicesconsistent with the Member's "special need" in accordance with GHP Family’s standards and within the scope of thespecialty training and clinical expertise. In order to accommodate the full spectrum of care, the SCP as a PCP also musthave admitting privileges at a hospital in GHP Family’s Network.PCPs are responsible for initiating and coordinating referrals of Members for Medically Necessary services beyond thescope of their contract of practice. PCPs and SCPs must monitor the progress of the referred Members’ care and SCPsmust see that Members are returned to the PCP’s care as soon as medically appropriate.APPOINTMENT STANDARDSGHP Family works with providers to outreach to HealthChoices Members concerning appointments for MedicallyNecessary care, preventive care and scheduled screenings and examinations. Contracted GHP Family providers areresponsible to adhere to the appointment availability standards for Members. Providers must monitor the adequacy oftheir appointment processes and reduce unnecessary emergency room visits.Condition Member(s) Provider Types StandardsEmergency All PCP Recipients must be seen immediately orreferred to an emergency facility.SCPAppointments immediately upon referral.Urgent All PCP Appointments must be scheduled within 24hours.SCPAppointments within 24 hours of referral.Routine All PCP Appointments must be scheduled within 10Business Days.17