Primary Care Services

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

The primary care physician (PCP) is responsible for the management and coordination of a member's medical care, including initial and primary care, maintaining continuity of care, and initiating specialist referral. The PCP refers the member to a specialist when additional knowledge or skills are required.

Health Net has delegated the referral process to some participating physician groups (PPGs). Referrals to participating and non-participating specialists for capitated members are subject to any additional rules imposed by the PPG. PPGs may not impose referral or authorization requirements that conflict with the member's right to self-refer for services.

Listed below are examples of services that are considered primary care services. A PCP is expected to have the expertise necessary to perform most of these services. The PCP must have received relevant training within the limitations of scope of practice that is consistent with state and federal rules and regulations. These guidelines are based on routine, uncomplicated cases where care is provided by a PCP. This list provides guidelines, is not intended to be all-inclusive, and should be used with discretion.