Primary Care Case Management. Medicaid m anaged care option allowed under section 1915(b) o f the Social Security Act in which each participant is assigned to a single primary care provider who must authorize most other services such as specialty physician care before they can be reimbursed by Medicaid. See gatekeeper.
Primary Care Case Manager. An authorized health care provider who agrees to provide primary care services to clients and coordinate other medical care. The PCCM receives a monthly case management fee for each client managed and a fee-for-service reimbursement for medical care provided to the client. See: Managed Care
Primary Care Case Manager. Refer to PCCM for definition. See: Managed Care
Primary Care Case Management. A Medicaid managed care program in which an eligible individual may use services only with authorization from his/her assigned primary care provider. The provider is responsible for locating, coordinating, and monitoring all primary and other medical services for enrollees.
Primary Care Case Manager. PCCMs are physicians, physician groups, or entities that have arrangements with physicians that contract with state Medicaid agencies to coordinate and monitor the use of covered primary care services by enrolled beneficiaries. State Medicaid contracts with PCCMs tend to be less comprehensive in their coverage of benefits and involve less financial risk than those with MCOs. PCCMs are typically paid a small administrative fee monthly for each beneficiary under their care while services are reimbursed on a fee for service basis.
Primary Care Case Management Model
See Primary Care Case Management.
Primary Care Case Management. A form of state-managed Medicaid in which beneficiaries select a primary care physician, who is paid a flat monthly fee and must approve and monitor the use of Medicaid services. Other providers are paid as under a traditional Medicaid program.
A Primary Care Case Management program is a Freedom of Choice Waiver program, under the authority of section 1915(b) of the Social Security Act. States contract directly with primary care providers who agree to be responsible for the provision and/or coordination of medical services to Medicaid recipients under their care. Currently, most PCCM programs pay the primary care physician a monthly case management fee in addition to receiving fee-for-services payment.
Primary Care Case Management. PCCM is a type of managed care that provides a medical home for Medicaid clients through primary care providers (PCP) who are paid on a fee-for-service basis. See also THN.
primary care case manager. In states that have obtained a Section 1915(b) waiver, a primary care provider who contracts directly with the state to provide case management services, such as coordination and delivery of services, to Medicaid patients in an effort to reduce emergency room use, increase preventive care, and improve overall effectiveness by fostering a close physician-patient relationship.