UNDERSTANDING PCP ASSIGNMENT
Before giving care
Our members can only see their assigned PCP or an affiliated, covering PCP in our network.
To make sure your claims are paid, please verify your patients’ assigned PCP before giving care. You can help your patients change PCPs in Availity.
Frequently Asked Questions
Find answers you need
We’ve answered commonly asked questions you may have about PCP member assignment. For questions not answered below, review our myBluePCP FAQs.
See more FAQs-
How can I make sure my patients are assigned to me?
You can view your PCP Member Roster in Availity. Each member’s PCP is also listed on their Member ID card. Please check the ID card or your Member Roster in Availity to confirm assignment before providing care.
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How often are member rosters updated?
PCP Member Rosters are updated weekly, on Tuesdays.
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Are any members excluded from the PCP assignment requirement?
Yes. Those excluded from this requirement include:
- Retro-eligible members
- Dual-eligible members
- Babies who are 90 days old or younger
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What if I need to cover another provider?
Providers can cover for one another and receive reimbursement if these criteria are met:
For PCPs with a group affiliation- All participating PCPs who are in the same group and have the same tax ID are systematically loaded as covering for each other.
- All PCPs who have the same tax ID but are in different groups can be loaded as covering for each other based on information provided from your office.
- If you’re not affiliated with a group, we’ll manually load the covering provider information we get from your office..
Please note: Specialists can’t be loaded as covering for a PCP.
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How can my patients change their PCP?
Your patients can request a PCP change in their online account or by calling the Customer Service number for their plan:
BlueCare℠ – 1-800-468-9698
TennCareSelect – 1-800-263-5479
CoverKids – 1-888-325-8386
You can also find these phone numbers on the back of their Member ID card. -
Can I change a patient’s PCP assignment?
Yes. You can make this change for patients in Availity using the BlueCare PCP Change Maintenance application. This application makes changes in real time, and your patients get an updated digital and hard copy of their Member ID card automatically.
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How long does it take to process PCP change requests?
PCP change requests are effective immediately on the date of the request. If you use the BlueCare PCP Change Maintenance application, changes are made in real time. As soon as the change is made, the member will appear in your Member Roster, and they’ll be able to view their updated Member ID card in their BlueCross online account.
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I’m a PCP, and I see patients assigned to me in a traditional office setting. I also care for patients in settings outside of my PCP office. Will my claims for services delivered in non-traditional settings, like a rural health clinic or urgent care center, be denied?
We understand that some PCPs with assigned members practice in locations other than a traditional office setting. If you provide services to members who aren’t assigned to you at any of the below locations, we encourage you to file the appropriate location code on your claim to avoid claim denials.
LOCATION DESCRIPTION LOCATION CODE Telehealth 02 School 03 Mobile Unit 15 Walk-in Retail Health Clinic 17 Urgent Care Center 20 Federally Qualified Health Center (FQHC) 50 Public Health Clinic 71 Rural Health Clinic 72
MAKING PCP UPDATES
Guidance for changing PCP assignment
Please use the Availity BlueCare PCP Change Maintenance application to change a patient’s PCP. As of April 1, 2024, we no longer accept PCP change requests by fax or email.
Your patients can request a new PCP in their online account or by calling the customer service number for their plan. These phone numbers are also available on the back of their Member ID card.
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