Primary care provider roles and responsibilities
The PCP’s role is to provide members with a medical home, the member’s first stop in the health care process and a centralized hub for a wide variety of ongoing health care needs.
The PCP’s role is to:
- Complete an Initial Health Appointment within 120 days of enrollment.
- Help members schedule appointments with other providers and health education programs.
- Track and document appointments, clinical findings, treatment plans and care received by members referred to specialists or other health care providers to ensure continuity of care.
- Screen and evaluate procedures for detection and treatment of or referral for any known or suspected behavioral health problems and disorders.
- Refer members to specialists or specialty care, behavioral health services, health education classes and community resource agencies, when appropriate.
- Coordinate with the Woman, Infants and Children (WIC) program to provide medical information necessary for WIC eligibility determinations such as height, weight, hematocrit or hemoglobin.
- Coordinate with the local tuberculosis (TB) control program to ensure that all members with confirmed or suspected TB have a contact investigation and receive Directly Observed Therapy (DOT).
- Refer members to specialists or specialty care, behavioral health services, health education classes and community resource agencies including the California Department of Developmental Services regional centers, which are responsible for the Early Start Program (ESP) for children up to 3 years of age with developmental disabilities. Community resources also include the Child Health and Disability Prevention Program (CHDP), and California Children's Services (CCS).
Continuity of care
Anthem Blue Cross (Anthem) will work with PCPs and medical groups (when applicable) to facilitate the continuity of care/transition of care (COC/TOC) when members need assistance in transitioning to in-network providers or facilities. The goal of this process is to minimize service interruption and to assist in coordinating a safe transition of care.
This also applies to dually eligible members (Medicare and Medi-Cal) and members who are transitioning from Medi-Cal Fee-For-Service (FFS) to enrolled members of Medi-Cal Managed Care (Medi-Cal). For more guidance on members’ rights to continuity of care, please use our resources and information available through the Department of Health Care Services (DHCS).
Continuity of Care resources
How to verify a member has designated you as their primary care provider
Members enrolled in Anthem Blue Cross (Anthem) may select any contracted PCP as their primary physician as long as that PCP is taking new patients. We furnish each PCP with a current list of assigned members and from time to time provide medical information about our members’ potential health care needs. In this way, providers can more effectively provide care and coordinate services.
Providers can verify that a member is assigned to them any time via Availity. Log in to the Provider Online Reporting tool to view the monthly PCP rosters. For other ways to get in touch regarding PCP verification, please refer to your provider manual or visit the Contact Us page.
Tobacco Cessation Requirements for Medi-Cal providers
- Asthma management.
- Childbirth/Lamaze/Prenatal education.
- Diabetes management.
- Injury prevention.
- Parenting/well child.
- Smoking cessation/tobacco prevention.
- Substance abuse.
- Health & Wellness
- WIC Programs Forms and Information
- Recommendations For Preventive Pediatric Health Care - Bright Futures/American Academy of Pediatrics periodicity schedule
Related resources for PCPs
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Reimbursement Policies
- Provider Manuals, Policies & Guidelines
- Provider Training Academy
- Pharmacy Information
- Provider News & Announcements