A PCP is a specific clinician responsible for coordinating the health care needs of certain members. Providers with the following specialties can be designated as PCPs: general practice, family practice, internal medicine, pediatrics, OB/GYN, physician assistants, certified nurse midwives and advanced practice nurses (nurse practitioners).
When members enroll in any of our programs, they choose a PCP or are assigned one. PCPs agree to accept member assignment and are the principle point of contact for our members in coordinating and managing their care.
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. UniCare Health Plan of West Virginia, Inc. (UniCare) furnishes each PCP with a current list of enrolled members assigned to that PCP.
The PCP’s role is to:
The PCP’s scope of responsibilities includes providing or arranging for:
UniCare keeps providers up-to-date with detailed member information. We also furnish each PCP with a current list of assigned members and provide medical information about the members’ potential health care needs. Providers may use this information to provide care and coordinate services more effectively.
PCPs should provide services only to those UniCare members who have chosen you as their PCP. Verify that a member is assigned to you by using the following methods:
* Availity, LLC is an independent company providing administrative support services on behalf of UniCare Health Plan of West Virginia, Inc.
PCPs coordinate and make referrals to specialists, ancillary providers and community services. Providers should refer members to network facilities and providers. When network facilities and providers are not available, providers should follow the appropriate process for requesting out-of-network referrals.
Please note: Specialty referrals to in-network providers do not require prior authorization.
For a full list of guidelines for primary care provider referrals, please refer to the Provider Manual.
For the full list of forms related to referrals, patient care coordination, claims and more, please visit the Forms page.