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:
- 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).
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.
Staying Healthy Assessment — For Medi-Cal Managed Care (Medi-Cal) only
The Staying Healthy Assessment (SHA) is the California Department of Health Care Services’ (DHCS’s) Individual Health Education Behavior Assessment (IHEBA). Medi-Cal providers are required to use and administer the SHA to all members enrolled in Medi-Cal as part of the Initial Health Assessment (IHA) and periodically re-administer it according to contract requirements.
Note: This requirement does not apply to members enrolled in Major Risk Medical Insurance Program (MRMIP).
PCP responsibilities for the SHA include:
- Reviewing the completed SHA with the patient.
- Exploring patient responses to verify risk factors and determining the extent to which they might harm the patient’s health.
- Based upon a patient’s behavioral risks and willingness to make lifestyle changes, PCPs should provide tailored health education counseling, intervention, referral and follow-up.
- The PCP must document, initial and date all health education interventions and referrals using the intervention codes listed on the bottom of each SHA tool.
Newly added PCP responsibilities for SHA include:
- Receive training on implementing and administering the new SHA
- Attest to receiving training on the implementation, administration and state regulations regarding the use of the new SHA assessment forms
- Complete the DHCS-approved provider presentation training online
To obtain SHA forms
The SHA forms in all the age categories and most Medi-Cal threshold languages are posted on the
DHCS SHA webpage.
Tobacco Cessation Requirements for Medi-Cal providers
Anthem is responsible for ensuring PCPs and their qualified staff implement the interventions outlined in
MMCD Policy Letter 16-014
. This includes identifying all members, initially and annually, of any age who use tobacco products or are exposed to tobacco smoke and document this information in the member’s medical record. This can be accomplished by using the SHA or an equivalent, approved assessment. Providers must ask tobacco users about their tobacco status at every visit and document their responses in their medical record.
Related resources for PCPs
For information related to long-term services and supports (LTSS), interpreter assistance, community-based adult services (CBAS)
and other programs, please visit the Provider Training Academy page