Yes this can be done by two method.
MEMBERS INITIATING PCP TRANSFER:
In order to maintain continuity of care, CarePlus encourages its members to remain with their PCP.
However, a member or power of attorney/guardian may request to change the PCP by contacting CarePlus’ Member Services Department or submitting a written request.
* The effective date of the change will be the first day of the following month.
* Special circumstances may provide for a mid-month PCP change. In such situations, both physicians’ offices will be contacted by the Member Services Department to add or delete a
member from the monthly membership list.
* The primary care office must send his/her medical records to the newly selected primary care
PHYSICIAN INITIATING MEMBER TRANSFER:
Reasonable efforts should always be made to establish a satisfactory provider and member relationship. The provider should provide adequate documentation in the member’s medical records to support his or her efforts to develop and maintain a satisfactory provider and member elationship. If a PCP wishes to transfer a member to another PCP, the PCP must prepare a Physician Initiated Request Member Form and forward it with supporting documentation to the CarePlus Provider Operations Department or their designated Provider Service Executive. The form is included as part of this manual. The PCP will be notified of CarePlus’ decision. If the request is approved by the Plan, the member’s care remains the responsibility of the PCP requesting the transfer until the change is effective. PCPs may not, in any way, coerce a member to transfer. Furthermore, a PCP may not seek or request to terminate their relationship with a member or transfer a member to another provider of care, based upon the member’s medical condition, amount or variety of care required or the cost of covered services required by the Plan’s member. Any primary care office that violates guidelines for transferring members to another office is given a 30-day, noncompliance written notification requiring immediate corrective action. No further written notice is necessary to terminate the participation agreement if the primary care office is found in violation of established policies and procedures and is, therefore, considered to be non-compliant. Members or their power of attorney/guardians have the right to file a formal grievance if they do not agree with the transfer. Refer to the “Involuntary Disenrollments” for additional information.
MEMBER DISENROLLMENT PROCEDURE:
A member may only disenroll from CarePlus during a valid election period. Some members may have special circumstances. For disenrollment procedures, please refer members to the Member Services Department for assistance.
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