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PAP616

Primary Care Physician Requested Transfer


Provider Administrative Policy

Section
Commercial Managed Care
Policy Date
July 2007
Status/Date
Reviewed/May 2008
Provider Type(s)
Physician  

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 Requested Transfer

A primary care physician (PCP) may, for reasonable cause, request that a member select another PCP.

PCP requests for member transfers shall be submitted to Blue Cross of Idaho in writing and include documentation that supports the PCP’s request. The transfer request must also include a letter from the PCP notifying the member of the requested transfer. The PCP’s responsibility to provide care shall cease upon written approval of the transfer by Blue Cross of Idaho. Blue Cross of Idaho shall not unreasonably withhold transfer approval.

Enrollment and billing services will send a letter to the member requesting he/she choose a new PCP. The letter will specify that the PCP initiated the request for transfer. The member must complete and return the change request portion of the letter or call customer service with the new PCP selection within 30 days. If the member does not select a new PCP at the end of 30 days, the record will reflect “no PCP” and benefits will be paid at a lower reimbursement.

The PCP shall facilitate any such transfers by promptly forwarding appropriate medical records to the replacement PCP.


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