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Primary Care Physicians (PCPs)

Provider Administrative Policy

Provider Information
Policy Date
November 2007
Revised/May 2008
Provider Type(s)


Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.


Primary Care Physicians (PCPs)

A PCP is responsible for providing routine health care, including preventive health exams and treatment for illness and injury. A PCP is also responsible for coordinating a member`s health care with other participating providers, including providing medical records to any other provider participating in a member’s care.

The PCP is responsible for maintaining procedures to inform members of follow-up care, provide training in self-care and other measures taken to promote a member`s health.

When a PCP believes a referral to a specialist is necessary, he or she should follow the procedures for requesting an authorization (see MA PAP300). A PCP will provide necessary information to the authorized provider including related clinical summaries; history and physicals, results of diagnostic work-ups, treatment plans and progress notes and other measures to promote a member`s health.

Policy History

Date Action Reason
May 2008 Revised Language clarification

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