Providers Responsibility to Refer to Participating Providers
It is the provider ’ s responsibility to refer members to participating providers in the Hometown Health network as outlined in the provider agreement . If Hometown Health identifies a member has been referred to an out of network provider , Hometown will require the referring provider to coordinate the resolution of the member ’ s out of pocket cost with the out of network provider within ten ( 10 ) business days of notice from Hometown Health or the member .
Primary Care Physician
Each PCP contracted with Hometown Health has the primary responsibility for coordinating comprehensive healthcare for members who select or are assigned to the physician as their PCP . These responsibilities include :
• Managing the delivery of covered health services to these members in accordance with the physician ’ s agreement with Hometown Health ;
• Obtaining the appropriate authorizations / referrals to specialists and other providers under contract with Hometown Health when required ;
• Providing care for all routine office visits and related services of the physician and other providers received in the physician ’ s office , including evaluation , diagnosis and treatment of illness and injury ;
• Providing visits and examination , including consultation time ; time for personal attendance with the members during a stay in a hospital , skilled nursing facility or other facility , including the member ’ s home if necessary ;
• Administering injections ;
• Providing well-child care from birth in accordance with Hometown Health policies and protocols for pediatric members ;
• Providing periodic health-appraisal examinations and applicable preventative health screenings and management ;
• Providing patient health education services and referrals as appropriate , including information and personal health patterns , appropriate use of health care services , family planning , adoption , and other educational and referral services ;
• Having telephone consultations with other physicians and members ;
• Submitting medical records upon request to another provider or to Hometown Health in accordance with the terms of the provider contract ;
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