Primary Care Physicians (PCP) Responsibilities
As a PCP, you are responsible to provide medically necessary primary care services. You are the coordinator of your patients’ total health care needs. You are responsible for seeing all members on your panel who need assistance, even if the member has never been in for an office visit.
Some benefit plans require PCPs to submit electronic referrals for the member to see another network physician. Go to Chapter 5: Referrals for detailed information on referral requirements.
Do not discriminate against any patient on quality of service or accessibility of services. You must keep policies and procedures to show your compliance. This includes discrimination based on:
- Type of health insurance
- National origin
- Sexual orientation
- Claims experience
- Medical history
- Genetic information
- Type of payment
Cooperation with Quality Improvement and Patient Safety Activities
You must follow our quality improvement and patient safety activities and programs. These include:
- Quick access to medical records when requested.
- Timely responses to queries and/or completion of improvement action plans during quality of care investigations.
- Participation in quality audits, including site visits and medical record standards reviews, and Healthcare Effectiveness Data and Information Set (HEDIS®) record review.
- Allowing use of practitioner and provider performance data.