How are designated PCPs selected or changed?
The member's designated PCP must be a medical professional (M.D., D.O., or N.P.), actively practicing as a PCP, and contracted with BCBSAZ to participate in the Neighborhood Network. Specialties include:
- Internal Medicine
- Family Medicine
- General Practice
- Pediatrics (for members up to age 19)
Members requesting their designated PCP to be an OB-GYN or Pediatrics sub-specialist provider will be approved on a case-by-case basis. The OB-GYN or Pediatrics sub-specialist will need to submit a PCP Consent Form to BCBSAZ in order to be approved.
PCP Selection – Using claims history, BCBSAZ connected renewing members with their most recently visited PCP. For new members, zip code information is used to make an initial PCP selection. In order to be selected, a PCP must have an office location outside of Maricopa County.
PCP Changes – Members may request a different designated PCP up to six times a year. To check the status of a member’s PCP change, do an online eligibility & benefits inquiry – the updated PCP selection is displayed on the member’s results page as soon as it becomes effective.
Remember, members will have no benefit coverage for office visits to PCPs other than their current designated PCP (or a covering PCP).
Where to find the member’s designated PCP information
The current PCP name and designation effective date are displayed on the member ID card. The designated PCP is also shown on the results page of the online Eligibility & Benefits Inquiry tool.
On the member ID card:
On the Eligibility and Benefits results page:
Neighborhood Network Providers who have been selected as a designated PCP for a member with a Neighborhood HMO plan must have covering PCPs for times when they are not available. A covering PCP must be an MD, DO or NP, actively practicing as a PCP, and contracted for participation in the network associated with the member's benefit plan. Neighborhood Network PCPs within the designated PCP’s practice (same tax ID) who meet the above qualifications will be considered covering PCPs – no notification to BCBSAZ is necessary.
Designated PCPs who do not have covering PCPs within their practice (same tax ID) must notify BCBSAZ of covering PCPs (and any changes). Up to three covering PCPs can be kept on file at any one time. Use the Covering PCPs Form to notify BCBSAZ of other covering PCPs (different tax IDs).
Designated PCP Panel Rosters
Designated PCPs can download a list of currently attributed members. Click on the PCP Panel Roster link in the Eligibility & Benefits section, under the Neighborhood HMO header.