Role of the PCP

PCPs play an integral part in coordinating health care for CareSource members. PCPs provide:

• Availability of a personal physician to assist with coordination of a member’s overall care, as appropriate for the member.
• Continuity of the member’s total health care.
• Early detection and preventive health care services.
• Elimination of inappropriate and duplicate services.

PCPs are also responsible for:

• Identifying the member’s health needs and taking appropriate action.
• Providing phone coverage for handling patients’ calls 24 hours a day and 7 days a week.
• Following all referral and prior-authorization policies and procedures as outlined in this manual.
• Complying with the quality standards of our health plan and the Ohio Department of Job and Family Services as outlined in this manual.
• Providing 30 days of emergency coverage to any CareSource patient dismissed from the practice.
• Obtaining patient records from facilities visited by CareSource patients for emergency or urgent care if notified of the visit.