Common use of PCP Panel Monitoring Clause in Contracts

PCP Panel Monitoring. The MCO must maintain written policies and procedures for monitoring participating PCP panel status and capacity. At a minimum, MCO policies and procedures must capture PCP panel capacity monitoring, PCP notifications of its panel size, changes in the PCP panel status, and limits. The MCO must furnish each PCP with a current list of enrollees assigned to that provider no later than five (5) business days after the end of each month, unless the PCP agreed to an alternative schedule. The MCO may offer and provide such information in alternative formats, such as through access to a secure internet site, when such format is acceptable to the PCP. The MCO must have a process in place to allow for enrollee reassignment upon PCP request if the enrollee falls outside the provider’s provider type.

PCP Panel Monitoring. The MCO must maintain written policies and procedures for monitoring participating PCP panel status and capacity. At a minimum, MCO policies and procedures must capture PCP panel capacity monitoring, PCP notifications of its panel size, changes in the PCP panel status, and limits. The MCO must furnish each PCP with a current list of enrollees members assigned to that provider no later than five (5) business days after the end of each month, unless the PCP agreed to an alternative schedule. The MCO may offer and provide such information in alternative formats, such as through access to a secure internet site, when such format is acceptable to the PCP. The MCO must have a process in place to allow for enrollee member reassignment upon PCP request if the enrollee member falls outside the provider’s provider type.