Primary Care Case Management. The provision or arrangement of enrollees’ primary care and the referral of enrollees for other necessary medical services on a twenty-four hour (24–hour) basis.
Primary Care Case Management. The provision or arrangement of Enrollees’ primary care and the referral of Enrollees for other necessary medical services on a 24-hour basis. Primary Care Provider (PCP)— A Health Plan staff or contracted physician practicing as a general or family practitioner, internist, pediatrician, obstetrician, gynecologist, advanced registered nurse practitioners, physician assistants or other specialty approved by the Agency, who furnishes Primary Care and patient management services to an Enrollee. See Sections 641.19, 641.31 and 641.51, F.S. Prior Authorization— The act of authorizing specific services before they are rendered. Protocols— Written guidelines or documentation outlining steps to be followed for handling a particular situation, resolving a problem or implementing a plan of medical, nursing, psychosocial, developmental and educational services. Provider — A person or entity that is eligible to provide Medicaid services and has a contractual agreement with the Health Plan to provide Medicaid services. Provider Contract — An agreement between the Health Plan and a health care Provider as described above.
Primary Care Case Management. The provision or arrangement of Enrollees’ primary care and the referral of Enrollees for other necessary medical services on a 24-hour basis. Primary Care Provider (PCP)— A Health Plan staff or contracted physician practicing as a general or family practitioner, internist, pediatrician, obstetrician, gynecologist, advanced registered nurse practitioners, physician assistants or other specialty approved by the Agency, who furnishes Primary Care and patient management services to an Enrollee. See sections 641.19, 641.31 and 641.51, Florida Statutes. Prior Authorization— The act of authorizing specific services before they are rendered. Protocols— Written guidelines or documentation outlining steps to be followed for handling a particular situation, resolving a problem or implementing a plan of medical, nursing, psychosocial, developmental and educational services. Provider — A person or entity that is eligible to provide Medicaid services and has a contractual agreement with the Health Plan to provide Medicaid services. Provider Contract — An agreement between the Health Plan and a health care Provider as described above.
Primary Care Case Management. A service delivery control system in which physicians, ARNPs, in independent or group practices, local health departments, or clinics act as primary care providers. FQHCs and RHCs shall enroll as PCCMs. Primary care case managers are responsible for initiating or approving specified medical services for participating enrollees.
