In order to schedule an appointment, the patient has to be booked to the appropriate provider and to the resources that can provide the care. It is critical that the appropriate limitations of each provider be approved and entered into the patient appointment system before patients are scheduled for that provider. Any patient limitations on age, sex, procedures, examinations, or medical conditions within a specialty, which the provider does not treat or accept, have to be delineated in the appropriate detail field or in the slot comment field. Provider time must be taken to accomplish this, and it must be approved at a level consistent with local or regional policy before being entered into the appointment system. If this process is not done properly, schedulers, clinic personnel, and patients waste time.
Providers who work in more than one clinic specialty, change to another specialty clinic, or leave the MTF must be updated or removed from the system immediately. The following are the critical factors to keep in mind in provider templating:
Provider File and Table Build
- Detail fields and optional slot comments must be entered for all providers.
- Detail fields and optional slot comments must be reviewed and approved at the MTF level before they are activated. If this does not occur, schedulers and patients experience unnecessary delays in coordination of appointments at centralized Managed Care Support Contractor (MCSC) or MTF call centers.
- Detail fields and the optional slot comments should be updated at least once a year by the provider and when changes occur. A review should be made and the MTF approval obtained to activate the changes into the appointment system.
- If detail fields or optional slot comments are not specified, the scheduler is able to book the provider for any condition in that specialty.
In order to successfully implement MCP, the Provider File and Table build must be completed accurately. Some important rules for successfully creating providers, groups, and PCMs are described below. This list is intended as a checklist for sites to ensure that providers and their appointments will appear on the MCP appointment screens. If any of the following data are incomplete, the Health Care Finder or MCP booking clerk will not see appointments for the provider on the appointment candidate list in Health Care Finder. This will impede access.
Rule #1: In MCP, each individual provider must be assigned to a Provider Group.
Rule #2: For a Provider Group, the following data must be completed as described:
Rule #3: For each individual provider, the following data must be completed as described:
- Each group must be assigned all the specialties, agreements, and places of care that will be assigned to any of the group's provider members. Agreements, places of care, and specialties must be activated. Each provider member participates in a provider specific subset of the group capabilities. Agreements, places of care, and specialties must be activated. If the group does not have a capability, that capability cannot be assigned to a group member.
- If the group is set up under the PCM model or has PCMs as members, the group must be assigned PCM capabilities by setting three flags. If these flags are not set, the group and group members will not show on the MCP PCM help lists and appointment lists. The three flags are: (1) To activate the group provider as a PCM, set the Activate Group Provider field to YES on the Provider Group Profile screen. (2) To create group PCM specialties, set the PCM flag to YES on the Place of Care IND PL1 screen in GNET. Set this flag for each specialty that will be available through any PCM in the group. (3) To activate PCM agreements, select an agreement type. On the Provider Group PCM Capacity screen, set the Activate Group PCM flag to YES. This indicates that the agreement supports primary care.
- Identify the group that the provider member is assigned to. The group must be created before the individual provider is defined in MCP. If the individual provider is a PCM, then the group must first be created as a PCM as described above.
- If all the providers in the group are PCMs, then the PCM flag is not required to be set for any individual provider member since all the providers are assumed to be PCMs. If only a subset of the providers in the group are PCMs, then the PCM flag is required to be set for those individuals. If the individual provider is a PCM, one flag should be set to activate the provider as a PCM. Select an agreement type in the Enrollment Mix function, and set the PCM flag to YES on the Individual Provider PCM Capacity screen. This flag indicates that the agreement supports PCM care. Follow these steps:
- Complete the professional category and gender.
- Select the group places of care where the provider member practices.
- Enter all the provider's agreements and places of care.
- Enter each specialty supported by the provider for each of the provider's place of care as applicable.