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 Healthcheck Exams, including Lead Screening and Immunizations when appropriate. 

To qualify as a PCP, a provider must practice in one of the following primary care areas:

• General practice
• Family practice
• Internal medicine
• Pediatrics
• Obstetrics/Gynecology

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:

• Identifying the member's health needs and taking appropriate action
• Providing phone coverage for handling patients' calls 24 hours a day and 7 days a week
• Following all referral and Prior Authorization policies and procedures as outlined in the Provider Manual 
• Complying with the quality standards of our health plan and the Ohio Department of Job and Family Services (ODJFS) as outlined in this manual
• Providing 30 days of emergency coverage to any CareSource patient dismissed from the practice
• Obtaining patient records from facilities visited by CareSource patients for emergency or urgent care if notified of the visit

Access standards

CareSource has a comprehensive quality improvement program to help ensure our members receive the best possible health care services. It includes evaluation of the availability, accessibility and acceptability of services rendered to patients by participating health care providers. 

Please keep in mind the following access standards for differing levels of care. Participating providers are expected to have procedures in place to see patients within these timeframes and to offer office hours to their CareSource patients that are at least the equivalent of those offered to any other patient. Thank you for adhering to these standards.

Primary Care Providers (PCPs)

Non-PCP specialists

For certain specialties with higher demand (such as dental, dermatology, orthodontia, endocrinology and orthopedics), patients with routine care needs should be seen within 16 weeks.

*A member should be seen as expeditiously as the member's condition warrants based on severity of symptoms. It is expected that, if a provider is unable to see the member within the appropriate timeframe, CareSource will facilitate an appointment with a participating provider or a non-participating provider, if necessary.