PCP CHANGE- ENROLLED AND FUTURE ENROLLED ONLY
( DO NOT REQUEST AN ID CARD OR UPDATE PCP IF ACCOUNT IS DISENROLLED)
 
1) check enrollment status if enrolled proceed to the request
 
2) Confirm the name and address of the PCP
3) for enrolled member- ask 3 probing questions
- when was the last time time you saw the current pcp?= cannot remember=effective date is today
- Have u seen any other pcp for the last 48 hrs? = yesterday= effective date is next day. if today effective date is after 2 days
- what is the reason why you want to change ur pcp?= select the nearest concern
 
for future enrolled -
--ask only the reason why they want to change the pcp.
please update the effective date to first day of their coverage.
effective date will be the same day of their enrollment period.
 
4) ASK IF MEMBER HAS A PREFFER PROVIDER
(always look for internal medicaine , family practice and pediatric for 19 y/old below member- skip the not accepting patients provider )
 
- Always ask the name and address  of the PCP
- you can also ask for the phone number or NPI (NATIONAL PROVIDER ID)
(not all members have the doctors NPI so always ask for the name and address
 
5) Ask the member if they want the doctor to be their new pcp if yes.
then read the information showing on screen.
- Effective date of the change
- Arrange a baseline physical with the new PCP
- Provice the name and address of the new PCP
- ID card timeframe (7-10 business days)
 
NOTE: ESSENTIAL PLAN MEMBER WILL NOT RECEIVE AN ID CARD FOR PCP CHANGE REQUEST
INSTEAD THEY WILL RECEIVE A LETTER CONFIRMING THE CHANGE OF THE PCP
 
ALL THE HEALTHFIRST ID CARD HAS THE DOCTORS NAME ON IT EXXCEPT ESSENTIAL PLANS CG
ESSENTIAL PLAN MEMBER HAS AN ID CARD BUT IT DOESNT HAVE A DOCTORS NAME ON It
 
6) OFFER APPOINTMENT IF MEMBER REFUSED AND NO ATTEMPOT TO CONTACT THE PCP
PLEASE FOLLOW THIS Documentation
 
- case type:member support\case
subtype: Appointment scheduling
Customer requested callback : NO
Request reason: APPOINTMENT Inquiry
Member will contact provider directly
comments: interaction id 
provider phone number
 
7) ask further assistance - is there anything else i can help you with today?
 
 
8) OFFER Survey
9) CLOSING SPIEL - MUST PROVIDE THE WORD HEALTHFIRST

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