Member Dismissals Initiated by a PCP
We recognize there are certain instances a PCP may choose to terminate a patient relationship. While we will not interfere with the PCP’s decision, we will:
- Remind the PCP of their obligation to terminate the relationship in accordance with applicable requirements,
- Help ensure that the PCP provides us a reason for making the decision, and
- Require documentation that they have communicated this decision to the member.
Each dismissal should be carefully considered based on the facts and circumstances specific to the member.
In addition, PCPs who wish to terminate their relationship with a Medicare Advantage (MA) member (dismiss) and have a member reassigned must:
- Comply with all applicable legal and regulatory requirements;
- Send a certified letter to the member (evidence that the letter was mailed is acceptable even if a letter comes back as “undeliverable as addressed”);
- Provide continuity of care as required by applicable laws and regulations for no less than 30 days from the member’s receipt of the dismissal letter; and
- Provide us written notice.
Required Information from the PCP
For member reassignment, we require information from the PCP:
- PCP’s reason for reassignment or termination
- Member’s name, date of birth, address, and member ID
- PCP’s name, NPI, and TINs
- Copy of certified letter the PCP sent to the member notifying them of the termination
We use good faith efforts to reassign the member to another PCP within 90 days of receipt of request. Changes will not be applied retroactively.