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Verification of PCCM Primary Care Provider on Medicaid ID Required
Information posted February 23, 2007: For dates of service beginning April 13, 2007, PCCM clients will be required to obtain care from the primary care provider listed on their Medicaid Identification Form (H3087/3087). The transition period that previously allowed clients to receive health care from any provider while changing their primary care provider will end on April 12, 2007. Click on the title to view the details.
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Clients can continue to call 1-888-302-6688 to request a primary care provider change. It may take up to 45 days for the change to be listed on the client’s Medicaid ID. The daily Primary Care Provider Change List will not be available after April 12, 2007. If a PCCM client has not yet selected or been assigned to a primary care provider, any primary care provider may provide services. Clients who do not yet have a primary care provider will have on their Medicaid ID either “PCCNEWB01” (newborns) or “PCCPCCM01” (all clients except newborns) in place of the primary care provider’s name.
Providers can continue to verify client eligibility in four ways:
Primary care providers must continue to provide their TPI numbers to specialists to ensure appropriate claims processing. Claims with invalid or missing provider numbers will be denied.
Primary care providers are required to make arrangements for after-hours care. Referrals are allowed to clinics that offer after-hours care. However, the after-hours provider must include the primary care provider’s TPI number on the claim to receive payment. Administrative referrals will be issued only for urgent situations. For information, call the PCCM Provider Helpline at 1-888-834-7226 or visit www.tmhp.com/C18/PCCM.
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