A primary care physician, utilization review, case management, local agency or managed care entity responsible for determining when and what services a patient can access and receive reimbursement for. An arrangement in which a primary care provider serves as the patient's agent, arranges for and coordinates appropriate medical care and other necessary and appropriate referrals. A PCP is involved in overseeing and coordinating all aspects of a patient's medical care. In order for a patient to receive a specialty care referral or hospital admission, the PCP must preauthorize the visit, unless there is an emergency. The term gatekeeper is also used in health care business to describe anyone (EAP, employer based case manager, UR entity, etc.) that makes the decision of where a patient will receive services. Gatekeeping - The process by which a primary care physician directly provides primary care and coordinates all diagnostic testing and specialty referrals required for a patient's medical care. Referrals and procedures usually are preauthorized by gatekeepers except in cases of emergency care.
A primary care physician responsible for overseeing and coordinating all aspects of a patient's medical care. In order for a patient to receive specialty care referral or hospital admission, the gatekeeper must preauthorize the visit unless there is an emergency. This person has a dual role as an advocate for patients and a guardian of institutional welfare.