PCP Coordination

Health Net sends new members a welcome packet that includes an initial health appointment (IHA) notification and information on how to schedule appointments with their primary care physicians (PCPs). The IHA notification instructs new members to schedule appointments with their PCP for their IHA.

PCPs must document all member contacts, including the scheduling of the IHA appointment or the member's refusal of an appointment in their medical record.

During the initial and subsequent health assessments, PCPs must inform members, parents or guardians of the need for and importance of periodic health assessments and reinforce the member's understanding of the need for routine health or Child Health and Disability Prevention (CHDP) program services at each medical encounter. PCPs are encouraged to schedule the next visit at the conclusion of the member visit. PCPs are also encouraged to use an appointment reminder system. If PCPs identify a medical condition during the IHA, diagnosis and treatment must begin with 60 calendar days. Justification for any delays beyond 60 calendar days must be documented in the member's medical record. If an appointment is scheduled, but missed or broken, PCPs must follow the procedure for missed or broken appointments.