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PAP636

Managed Care Physician Copays


Provider Administrative Policy

Section
Commercial Managed Care
Policy Date
April 2013
Status/Date
New/April 2013
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

Managed Care Physician Copays

Historically, all managed care plans required a primary care physician (PCP) be elected for each member. Recently, some employer groups chose to eliminate the PCP requirement. If a group no longer requires a PCP, the member's insurance card will display "not required" under the "primary care physician PCP" on the card.

Member copayments for a primary care provider will apply to physicians, independent nurse practitioners and nurse practitioners/physician assistants with sponsoring physicians who carry a managed care contract and are classified as one of the following specialty types:

  • Family practice
  • General practice
  • Geriatrics
  • Gynecology
  • Internal medicine
  • Obstetrics
  • Obstetrics & gynecology
  • Pediatrics
  • Public health & general preventive medicine
  • Urgent care clinic providers with one of the above specialties

A specialist copay will apply to any providers with specialty types other than what is listed above.

NOTE:  This policy applies only to those members that have "not required" in the "PCP" field of their insurance card.


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