YOUR PATIENTS’ MEDICAL HOME

Primary care provider member assignment

Learn how we're strengthening the doctor-patient relationship through assigned primary care providers (PCPs).

Pediatrician showing information on digital tablet to mother of child

UNDERSTANDING PCP ASSIGNMENT

Before giving care

Our members can only see their assigned PCP or an affiliated, covering PCP in our network.

To make sure your claims are paid, please verify your patients’ assigned PCP before giving care. You can help your patients change PCPs in Availity.

Frequently Asked Questions

Find answers you need

We’ve answered commonly asked questions you may have about PCP member assignment. For questions not answered below, review our myBluePCP FAQs.

SEE MORE FAQS

How can I make sure my patients are assigned to me?
How often are member rosters updated?
Are any members excluded from the PCP assignment requirement?
Yes. Those excluded from this requirement include:
Retro-eligible members
Dual-eligible members
Babies who are 90 days old or younger
What if I need to cover another provider?
Providers can cover for one another and receive reimbursement if these criteria are met:
For PCPs with a group affiliation
All participating PCPs who are in the same group and have the same tax ID are systematically loaded as covering for each other.
All PCPs who have the same tax ID but are in different groups can be loaded as covering for each other based on information provided from your office.
For PCPs without a group affiliation:
If you’re not affiliated with a group, we’ll manually load the covering provider information we get from your office..
Please note: Specialists can’t be loaded as covering for a PCP.
How can my patients change their PCP?
Can I change a patient’s PCP assignment?
How long does it take to process PCP change requests?

I’m a PCP, and I see patients assigned to me in a traditional office setting. I also care for patients in settings outside of my PCP office. Will my claims for services delivered in non-traditional settings, like a rural health clinic or urgent care center, be denied?

We understand that some PCPs with assigned members practice in locations other than a traditional office setting. If you provide services to members who aren’t assigned to you at any of the below locations, we encourage you to file the appropriate location code on your claim to avoid claim denials.

LOCATION DESCRIPTION	LOCATION CODE
Telehealth	02
School	03
Mobile Unit	15
Walk-in Retail Health Clinic	17
Urgent Care Center	20
Federally Qualified Health Center (FQHC)	50
Public Health Clinic	71
Rural Health Clinic	72

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Happy male doctor surfing the Internet on a computer in the office at hospital

MAKING PCP UPDATES

Guidance for changing PCP assignment

Please use the Availity BlueCare PCP Change Maintenance application to change a patient’s PCP. As of April 1, 2024, we no longer accept PCP change requests by fax or email.

Your patients can request a new PCP in their online account or by calling the customer service number for their plan. These phone numbers are also available on the back of their Member ID card.

LAUNCH AVAILITY

YOUR PATIENTS’ MEDICAL HOME

UNDERSTANDING PCP ASSIGNMENT

Frequently Asked Questions

How can I make sure my patients are assigned to me?

How often are member rosters updated?

Are any members excluded from the PCP assignment requirement?

What if I need to cover another provider?

How can my patients change their PCP?

Can I change a patient’s PCP assignment?

How long does it take to process PCP change requests?

I’m a PCP, and I see patients assigned to me in a traditional office setting. I also care for patients in settings outside of my PCP office. Will my claims for services delivered in non-traditional settings, like a rural health clinic or urgent care center, be denied?

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MAKING PCP UPDATES

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I’m a PCP, and I see patients assigned to me in a traditional office setting. I also care for patients in settings outside of my PCP office. Will my claims for services delivered in non-traditional settings, like a rural health clinic or urgent care center, be denied?

MAKING PCP UPDATES

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