Primary Care Providers

The Primary Care Provider (PCP) is an integral part of CareSource. Through the PCP, CareSource delivers personalized, coordinated and systematic health care to its members. 

Among other things, the PCP is responsible for the EPSDT exam, including Lead Screening and Immunizations. 

To qualify as a PCP, a provider must have at least 50 percent of his or her practice in one of the following primary care areas:

  • Family/general practice
  • Internal medicine (providing care for patients 18 years of age and older, unless otherwise specified).
  • Pediatrics (providing care for patients up to age 18)

All CareSource members choose or are assigned to a PCP upon enrollment in the plan. Members select a PCP from the Provider Directory. We encourage new members to make an appointment with their PCPs within 90 days of enrollment. 

Members have the option to change to another participating PCP as often as once a month, if needed. Members initiate the change by calling our Service Center. 

For more information, please see the Provider Manual.

Role of the PCP

The Primary Care Provider (PCP) plays an integral part in coordinating health care for members of Caresource.

PCPs provide:

  • Availability of a personal physician to assist with coordination of a member's overall care, as appropriate for the member
  • Continuity of the member's total health care
  • Early detection and preventive health care services
  • Elimination of inappropriate and duplicate services

PCPs are also responsible for:

  • Establishing a minimum 20 hours per practice location per week for patient visits
  • Providing all routine and preventative medical services
  • Identifying the Member's health needs and taking appropriate action
  • Educating Members about maintaining healthy lifestyles and preventing serious illness
  • Providing phone coverage for patient emergency calls 24 hours a day, 7 days a week
  • Following all referral and prior-authorization policies and procedures as outlined in this manual
  • Complying with the quality standards and credentialing policies of our health plan and the Michigan Department of Community Health as outlined in this manual
  • Providing 30 days of emergency coverage to any Caresource patient dismissed from the practice
  • Obtaining patient records from emergency rooms and urgent care centers visited by CCM patients, if notified of the visit
  • Reporting all encounter data on the CMS 1500 (formerly HCFA 1500) form
  • Maintaining confidentiality of medical information

For more information, please see the Provider Manual.

Access standards

Participating providers are expected to have procedures in place to see patients within these time frames.

Providers shall have procedures in place that ensure:

  • Emergency care appointments are available the same day
  • Urgent care appointments are available within two days
  • Routine care appointments are available within 21 days
  • Annual physical exam appointments are available within 90 days

For maternity care, the provider shall provide initial prenatal care appointments for enrolled pregnant members as follows:

  • First trimester, within 14 days of first request
  • Second trimester, within seven days of first request
  • Third trimester, within three days of first request
  • High-risk pregnancies, within three days upon identification of high risk by health plan or maternity care Provider, or immediately in case of emergency