2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Centennial Care Overview3. Primary Care Providers3. Primary Care ProvidersPrimary care providers (PCPs) are contractedphysical health providers who meet certainobjective criteria established by Presbyterian. PCPsmust accept the responsibility for rendering primaryphysical health care 24 hours a day, seven days aweek (24/7) and coordinate referrals.Presbyterian’s network of PCPs specializes infamily practice, general practice, internal medicine,pediatrics, obstetrics, gynecology, and otherspecializations as approved by Presbyterian.Presbyterian’s PCP network also includes certifiedphysician assistants, certified nurse practitioners,and other specialists who are credentialed andelect to perform the role of a PCP. Providers canaccess help by calling the Presbyterian Provider E-Help Desk at 505-923-5590 or 1-866-861-7444 andchoosing option three.The Role and Responsibilities of the PCPPCPs play an integral role in providing care tomembers. They focus on the total well-being of themember and provide a “medical home” where themember can readily access preventive health careservices and treatment rather than episodic or crisishealth care treatment. Members are encouraged tobe involved in their health care decisions and tobuild a healthy lifestyle. The PCP is responsible forteaching members how to use the available healthservices appropriately. It is important to educatemembers to seek PCP services first, except inemergent or urgent health care situations.The PCP is responsible forProviding or arranging for the provision ofcovered services and telephone consultationsduring normal office hours, and on anemergency basis 24/7Providing appropriate preventive healthservices in accordance with programrequirements, medical policies, and the Earlyand Periodic Screening, Diagnosis, andTreatment (EPSDT) guidelines as applicableVaccinating members during PCP visitsinstead of writing a referral for immunizationsCoordinating with other contract providers toensure continuity of care for all coveredservices, including behavioral health and longtermcare servicesReferring a member for behavioral services,as applicable (see Behavioral Health chapter)Participating in the Interdisciplinary Care PlanTeam (for Centennial Care members)Maintaining current medical records that meetestablished Presbyterian standardsMaking referrals to contracted specialty careproviders, when appropriate3-12014 Practitioner and Provider Manual - Ver. 3