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7.5.7 Primary Care Provider Selection and Changes
7.5.7.1 Selecting a Primary Care Provider
The primary care provider selection process allows new PCCM clients to choose their primary care provider before one is assigned. Clients can select a primary care provider by calling the PCCM Client Helpline at 1-888-302-6688 or mail the PCCM Primary Care Provider Selection form to TMHP.
PCCM clients have up to 75 days to select a primary care provider and 105 days to select a primary care provider for their newborn. If clients do not make a selection within the specified time period, a primary care provider will be assigned.
Default Assignment
If a client does not exercise the right to choose a PCCM primary care provider, the client will be auto-assigned a primary care provider. The following factors are considered when processing a default assignment:
• Client's past claims history, taking into account an established relationship with a PCCM primary care provider.
•Client's age.
•Client's sex.
•Client's geographic proximity to the primary care provider.
PCCM clients are required to obtain health care from their selected or assigned primary care provider. If the Medicaid Identification Form (H3087) lists either PCCNEWB01 (newborns) or PCCPCCM01 (all clients except newborns) as the primary care provider, any PCCM enrolled primary care provider can render health-care services to the client.
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