Wednesday, May 29, 2013

What are Primary Care Physician Responsibilities

Primary Care Physician Responsibilities

The Primary Care Physician will provide Plan members with a medical home and is responsible for coordinating the member’s medical care, which includes the following:

• Providing routine and preventive care to ensure good health, disease prevention and early
detection Including, but not limited to: Diabetes, Asthma, Chronic Obstructive Pulmonary
Disease (COPD), Coronary Heart Disease, and Hypertension
• Ensuring medically necessary laboratory and radiology procedures are provided
• Treating acute illnesses and minor injuries
• Diagnosing and managing chronic disease
• Prescribing and monitoring medications
• Providing referrals for specialty care, diagnostic services, and hospitalization
• Following up on specialty services to ensure continuity of care
• Arranging or providing member health education
Including, but not limited to:
Disease process and management
Proper diet
Drug reactions/interactions
Medication compliance
Other risk factors (weight management, exercise, safety, smoking, alcohol, and drug use)
• Become familiar with the Plan’s non-covered services
• Become familiar with the Plan’s process requiring approvals of Pre-Service Requests
• Provide documentation demonstrating medical necessity when requested
• Comply with the Plan’s Utilization Management and Quality Management programs

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