COVID-19 vaccine news for Oregon Health Plan members
Learn more

Provider Notices

Primary Care Provider Capacity and Member Panel Changes an Reporting Requirement Reminders

4/19/2021 6:23:14 PM

 

What are the requirements for submitting PCP panel changes?

Provider or provider groups will notify their assigned Provider Service Representative of any PCP changes that will be occurring. All changes need to be submitted in writing prior to the effective date of the change. These notifications must be received within 30 days of the effective date change. Delayed notices received outside of the date requirements can have an impact on providers or provider groups with Capitated agreements. Provider or provider groups will need to work with their assigned Provider Service Representative. Delayed notice cases will require Provider Network leadership to review for approval. Delayed case determinations will be communicated by the assigned Provider Service Representative in writing. Providers with multiple delayed cases are subject to corrective action.

Who can request primary care provider (PCP) changes? 

Changes to PCP assignments can be made by PacificSource members or their appointed representative or caseworker. The healthcare professional serving as the primary care provider for the PacificSource member can also submit a PCP change.

How can I confirm a member’s PCP?

Up-to-date primary care provider information is available via our online portal, InTouch for Providers. For information about assignments and member eligibility, providers may to contact our Medicaid Customer Service team at (800) 431-4135 or CommunitySolutionsCS@PacificSource.com.

How can providers submit member PCP changes?

For changes involving ten or fewer members, please submit a PCP ChangeForm, or contact Medicaid Customer Service at (800) 431-4135 or CommunitySolutionsCS@pacificsource.com.

For changes to more than ten members, please contact your Provider Service Representative at (855) 247-7575 or ORProviderService@pacificsource.com.

How many PCP changes are allowed?

PacificSource does not limit the number of times a member may make changes to or reassign their PCP.

When do PCP changes become effective?

When a member calls PacificSource customer service directly, the PCP change is effective immediately. When submitting a change form by mail, the change will be effective on the first of the following month.

What is the PCP’s responsibility when notifying PacificSource Community Solutions of provider changes?

The PCP is expected to notify PacificSource Community Solutions of any changes that impact a member’s assignment. Please notify us within 30 days of the change. We also ask that newly assigned PCPs who are part of a provider group inform the group or practice.

If a provider is no longer associated with a group’s Tax ID, the provider group should notify their PacificSource Provider Service Representative of the change and provide any new member PCP assignments.

Where can I find the PCP Change Form?

The change form is available at our website, in Documents and Forms. For the PCP Change Form, click here.

Where can I find requirements for Primary Care Providers?

You are able to find more information within our Provider Manual that is available online, in Documents and Forms, click here.

What are the guidelines for reporting my provider’s member capacity?

Primary care practitioner will notify once per quarter their Provider Service Representative of their maximum capacity. (Note: any capacity of 1,000 or more requires supporting documentation to understand how calculations were determined.)

Definitions:

Capacity: The patient maximum threshold a primary care provider is assigned to manage their Medicaid member panel without impacting quality of care.

 

Please reach out to your Provider Service Representative with any questions regarding this notice.


Back