Common use of Primary Care Provider Clause in Contracts

Primary Care Provider. PCP shall serve as the Member’s initial and most important point of contact regarding health care needs (except in emergencies or for direct access benefits). Consequently, in addition to all other requirements hereunder, Preferred Providers who are PCPs shall meet the following minimum responsibilities: 4.3.1 Providing primary and preventive care, and acting as the Member’s advocate, providing, recommending, and arranging for care; 4.3.2 Maintaining continuity of each Member’s health care; 4.3.3 Where required, making referrals for specialty and other medically necessary services, both in and out-of-network; 4.3.4 Maintaining a current medical record for the Member, including documentation of all Provider Services rendered to the Member by the PCP, as well as any specialty or referral services (including procedures that are coded using the most current ICD coding classification system); 4.3.5 Providing office hours accessible to Members for a minimum of twenty (20) hours per week and being available directly or through on-call arrangements with other qualified Preferred Providers who are PCPs twenty-four (24) hours per day, seven (7) days per week for urgent and emergency care; and 4.3.6 Any additional standards imposed by Title 28, Section 9.678 of the Department of Health regulations (28 Pa. Code §9.678) implementing Article XXI of Act 68.

Primary Care Provider. PCP shall serve as the Member’s initial and most important point of contact regarding health care needs (except in emergencies or for direct access benefits). Consequently, in addition to all other requirements hereunder, Preferred Government Sponsored Programs Providers who are PCPs shall meet the following minimum responsibilities: 4.3.1 5.3.1 Providing primary and preventive care, and acting as the Member’s advocate, providing, recommending, and arranging for care; 4.3.2 5.3.2 Maintaining continuity of each Member’s health care; 4.3.3 5.3.3 Where required, making referrals for specialty and other medically necessary services, both in and out-of-network; 4.3.4 5.3.4 Maintaining a current medical record for the Member, including documentation of all Provider Services rendered to the Member by the PCP, as well as any specialty or referral services (including procedures that are coded using the most current ICD coding classification system); 4.3.5 5.3.5 Providing office hours accessible to Members for a minimum of twenty (20) hours per week and being available directly or through on-call arrangements with other qualified Preferred Government Sponsored Programs Providers who are PCPs twenty-four (24) hours per day, seven (7) days per week for urgent and emergency care; and 4.3.6 5.3.6 Any additional standards imposed by Title 28, Section 9.678 of the Department of Health regulations (28 Pa. Code §9.678) implementing Article XXI of Act 68.

Primary Care Provider. PCP shall serve as the Member’s initial and most important point of contact regarding health care needs (except in emergencies or for direct access benefits). Consequently, in addition to all other requirements hereunder, Preferred Providers who are PCPs shall meet the following minimum responsibilities: 4.3.1 Providing primary and preventive care, and acting as the Member’s advocate, providing, recommending, and arranging for care; 4.3.2 Maintaining continuity of each Member’s health care; 4.3.3 Where required, making referrals for specialty and other medically necessary services, both in and out-of-network; 4.3.4 Maintaining a current medical record for the Member, including documentation of all Provider Services rendered to the Member by the PCP, as well as any specialty or referral services (including procedures that are coded using the most current ICD coding classification system); 4.3.5 Providing office hours accessible to Members for a minimum of twenty (20) hours per week and being available directly or through on-call arrangements with other qualified Preferred Providers who are PCPs twenty-four (24) hours per day, seven (7) days per week for urgent and emergency care; andseven 4.3.6 Any additional standards imposed by Title 28, Section 9.678 of the Department of Health regulations (28 Pa. Code §9.678) implementing Article XXI of Act 68.