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MA PAP211

Primary Care Physician (PCP) Changes for True Blue HMO


Provider Administrative Policy

Section
Provider Information
Policy Date
July 2007
Status/Date
Reviewed/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

Primary Care Physician (PCP) Changes for True Blue HMO

If a member wishes to change their PCP, please ask them to call Medicare Advantage Customer Services (see MA PAP102). True Blue HMO members may change their PCP at any time. Provider changes are effective the first of the month following receipt of their request by Medicare Advantage Customer Services.

A PCP may, for reasonable cause, request that a member select another primary care physician. PCP requests for member transfers shall be submitted to a Blue Cross of Idaho Provider Relations representative in writing along with documentation supporting the PCP’s request for such transfer. The PCP’s responsibility to provide care shall cease upon written approval of the transfer by Medicare Advantage and its accomplishment by the PCP making and receiving such transfer. Medicare Advantage shall not unreasonably withhold such approval.

The PCP shall facilitate any such transfers by promptly transmitting appropriate medical records to his/her replacement PCP and continuing care, as appropriate, until completion of such transfer.


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