TMPPM 2008 > Provider Information > Managed Care > PCCM

7.5.7.3 Provider Initiated Primary Care Provider Changes

Occasionally, the relationship between a client and their primary care provider may become unsatisfactory to one or both parties. A provider may request a client be reassigned to another primary care provider for any of the following reasons:

•The client is not included in the primary care provider's scope of practice.

•The client is non-compliant with medical advice.

•The client consistently displays unacceptable office decorum.

•The client/primary care provider relationship is not mutually agreeable.

If the relationship with the client is unsatisfactory due to behavioral issues on the client's part, the primary care provider should contact PCCM CHS at 1-888-276-0702 to request assistance in resolving the problem. A community health coordinator can intervene and help providers with non-adherent and disruptive patients in most instances. The referral can also be made by submitting the PCCM Community Health Services Referral Request Form via fax to PCCM CHS at 1-512-302-0318. A copy of the PCCM Community Health Services Referral Request Form can be found on page B-68.

If the relationship with the client cannot be improved, the provider must notify TMHP in writing to request reassignment of a client to another primary care provider before the request can be processed. The primary care provider must also notify the client in writing stating the reason for the reassignment. A copy of the letter to the client may serve as notification to TMHP.

TMHP will notify the client of the reassignment in writing and request that the client choose another primary care provider. Primary care provider requests to reassign a client usually take 60 days before the change is made. During this time, the primary care provider is responsible for providing primary care to the client or referring the client to another provider for medically necessary care.