Primary Care Physician Designation-Blue Cross Blue Shield
Frequently Asked Questions (FAQs) for Colleagues
Primary Care Physician Designation
Frequently Asked Questions (FAQs) for Colleagues
As of April 13, 2018
- Why is Trinity Health implementing a Primary Care Physician (PCP) designation?
Maintaining a relationship with a primary care physician is an important step toward setting and meeting your health and well-being goals.Regular access to primary care is associated with improved health outcomes and better satisfaction with the overall health care experience.
PCPs are trained to recognize a wide variety of health and well-being issues and help support individual health and well-being goals to prevent serious, long-term health conditions. They are also prepared to partner with other physicians you may see.
- What is a PCP?
A PCP is the doctor seen routinely for chronic medical conditions, acute care, and prevention and wellness, including annual check-ups.
- Which types of physicians can be designated as a PCP?
The following physician types/specialties may be designated as a PCP:
- Internal Medicine
- Family Medicine
- General Practice
- Pediatricians
Note: Nurse Practitioners and Physician Assistants may not be selected as a PCP on the BCBS Doc-Find search tool. Please choose a physician in their practice and you will be able to continue seeing your regular provider.
- Who needs to designate a PCP?
All colleagues and their dependents (regardless of age) covered by a Trinity Health medical plan will be required to have a PCP on record by May 31, 2018.
- How do colleagues and dependents designate a PCP?
- Colleagues: Login to your Blue Cross Blue Shield online portal account at BCBSM.com. Review this job aid for step-by-step instructions.
- Dependents: Colleagues can designate a PCP for dependents under the age of 18. Dependents over the age of 18 must login to their own BCBS account to choose their PCP.
A PCP should be elected for the colleague and each dependent (regardless of age) covered under the medical plan.
Note: if your current PCP is showing on the BCBS search tool as not accepting new patients, you will need to contact the Customer Service number on the back of your BCBS ID card for assistance. Customer Service representatives will be able to update your information for you.
- Can I use the BCBSmobile app to designate a PCP?
Yes. Colleagues and dependents can view, select or modify their current PCP designation on the BCBS mobile app.
- When can I elect a PCP?
You may recall that at the beginning of the year, Trinity Health introduced the requirement for all colleagues and their dependents covered by a Trinity Health medical plan to select a Primary Care Physician (PCP). The deadline for making this selection was originally Jan. 31, 2018 but was suspended due to issues identified with the BCBSM portal. At this time, those technical issues have been resolved and the BCBSM portal will be available as of May 1, 2018. The new deadline for PCP selection is May 31, 2018.
8.If I previously selected a PCP before the requirement was suspended, do I need to do it again?
If you or any covered dependents on your contract have already selected a primary care physician, no further action is needed.To verify your PCP selection, login to bcbsm.comand follow the steps outlined in thisjob aid.
- What happens if I or one of my dependents does not designate a PCP by May 31, 2018?
If you and/or your enrolled dependents do not select a PCP, the plan will auto-assign a PCP based on the most recent primary care physician claim on file. This can be either a Tier 1 or Tier 2 provider. If a member has not seen a PCP recently and the plan cannot determine that the member has a PCP based on claims history, BCBS will auto-assign one based on the physician's proximity to the colleague's home. This will be either a Tier 1 or Tier 2 provider, but the default will be a Tier 1 provider where available.
- If I don't designate a PCP, how will I be notified of the PCP who has been assigned?
Colleagues and dependents who do not select a PCP by May 31, 2108, will receive a letter from BCBSnotifying them of their assigned PCP.
- Do I need a referral from a PCP to see a specialist?
No, you do not need a referral from PCP to access specialty care.
- Will claims be affected if there is no PCP on record?
No. Claims will pay according to the benefit design for the plan chosen regardless if a colleague designates their own PCP or if one is chosen for them by the plan.
- Can I see a different PCP than the onethat is on record?
Yes. You/your covered dependents can choose to see a different PCP than the one designated online. Claims will pay according to the benefit design for the plan chosen regardless of which PCP you see for services.
- How often can I changemydesignated PCP?
You and your covered dependents can change your PCP at anytime through the BCBSM website. However we recommend you change your PCP no more than once every 30 days.
- How do I change my designated PCP?
Members can change the PCP by going online to their BCBSM online portal atBCBSM.com. Review this job aid for step-by-step instructions.
Note: Dependents over the age of 18 will need to login to their own BCBSM account in order to change their PCP.
- Will the medical ID card list the designated PCP?
No. ID cards will not have the name of the designated PCP printed on them.
- Will I get a new ID card if I change my PCP?
No. There is no need for a new ID card since the name of the designated PCP is not printed on it.
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