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MA PAP207

Responsibilities of Contracted Specialists and Healthcare Professionals


Provider Administrative Policy

Section
Provider Information
Policy Date
November 2007
Status/Date
Revised/May 2008

Disclaimer

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.

Policy

Responsibilities of Contracted Specialists and Healthcare Professionals

Contracted specialists and healthcare professionals are responsible for providing evaluation and treatment as requested by the primary care physician (PCP) or member. If the member requires a procedure or service for which prior authorization is required, the contracted specialist or healthcare provider will submit a request with all pertinent medical documentation to the Medicare Advantage care coordination team allowing adequate time for medical review.

See  MA PAP300, MA PAP301,  MA PAP302MA PAP305 and MA PAP307

Contracted specialists and healthcare professionals are responsible for communicating medical updates to the member`s PCP, including medical records, for incorporation into the member`s primary care medical record.

The contracted specialist is responsible for maintaining procedures to inform members of follow-up care and provide training in self-care as necessary.

 


Policy History

Date Action Reason
January 2012 Revised Removed Reference to MAPAP303
May 2008 Revised Reference to MA PAP304 added

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