Primary Care Provider Roles & Responsibility

All CareSource members choose or are assigned to a primary care provider (PCP) when they enroll in the plan. They can change to another network PCP as often as needed. Members initiate the change by calling Member Services at 1-833-230-2058.

PCPs should help facilitate a medical home for members. This means that PCPs will help coordinate health care for the member and provide additional health options to the member for self-care or care from community partners.

Roles and Responsibilities

CareSource PCPs play an integral part in coordinating health care for our members by providing:

• Availability of a personal health care practitioner 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 Responsible For:

• Treating CareSource members with the same dignity and respect afforded to all patients. This includes high standards of care and the same hours of operation.
• Identifying the member’s health needs and taking appropriate action.
• Providing phone coverage for handling patient 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 of our health plan and the Ohio Department of Medicaid (ODM) as outlined in this manual.
• Providing 30 days of emergency coverage to any CareSource patient dismissed from the practice.
• Maintaining clinical records, including information about pharmaceuticals, referrals, inpatient history, etc.
• Obtaining patient records from facilities visited by CareSource patients for emergency or urgent care if notified of the visit.
• Ensuring demographic and practice information is up to date for directory and member use.