Eligibility and Data Entry Requirements
Provider Type
- Participating Physician Groups (PPG)
- Hospitals
All participating physician groups (PPGs) and hospitals are required to enter the following into the PPG's or hospital's system:
- Eligibility and primary care physician (PCP) assignment information within two business days after receipt.
- New member information that is not yet on eligibility or capitation reports upon verification of eligibility.
- PCP changes requested by the member within two business days of receipt of requested change.