Primary Care Provider Roles & Responsibility

All TrueCare members choose or are assigned a primary care provider (PCP) or Patient-Centered Medical Home (PCMH) upon enrollment in the plan.

PCPs should help facilitate a medical home for members. This means that PCPs will help coordinate health care for the member and provide additional health options to the member for self-care or care from community partners. This model provides many benefits to the member and the provider, including fewer hospital/emergency department (ED) visits, higher patient satisfaction, improved access for members in rural environments and higher quality at a lower cost to the health care system.

TrueCare encourages providers to attain National Committee on Quality Assurance (NCQA) patient-centered medical home (PCMH) recognition. We offer financial incentives to providers who have NCQA PCMH recognition. We also encourage members who are in medium or high-risk health stratification to select a PCMH, as required. To support providers working to attain NCQA PCMH accreditation, TrueCare offers free, consultative assistance to navigate the recognition process with NCQA. Contact your Provider Engagement Representative for more information.

In addition, providers are expected to administer patient care in a culturally competent manner.

Provider Types

To qualify as a PCP, a provider must practice in one of the following primary care areas:

  • General practice
  • Family practice
  • Internal medicine
  • Pediatrics
  • Obstetrics/gynecology
  • Endocrinology (if primarily engaged in internal medicine)
  • Certified nurse practitioner

If a member does not select a PCP, TrueCare will assign one.

Roles And Responsibilities 

PCP care coordination responsibilities include at a minimum, the following:

  1. Assisting with coordination of the member’s overall care, as appropriate for the member
  2. Serving as the ongoing source of primary and preventive care
  3. Recommending referrals to specialists, as required
  4. Triaging members
  5. Participating in the development of case management care treatment plans and notifying TrueCare of members who may benefit from care management
  6. Providing care that addresses the needs of MississippiCAN and CHIP members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health
  7. Providing a written plan and evidence of ongoing, increased communication between the PCP, TrueCare and the behavioral health provider

In addition, TrueCare PCPs play an integral part in coordinating health care for our members by providing:

  • Availability of a personal health care practitioner to assist with coordination of a member’s overall care, as appropriate for the member
  • Continuity of the member’s total health care
  • Early detection and preventive health care services
  • Elimination of inappropriate and duplicate services

PCPs are responsible for:

  • Treating members with the same dignity and respect afforded to all patients 
    • This includes high standards of care and the same hours of operation
  • Identifying the member’s health needs and taking appropriate action
  • Providing phone coverage for handling patients’ calls 24 hours a day, seven days a week
  • Following all referral and prior authorization policies and procedures as outlined in the Provider Manual
  • Complying with the quality standards of our health plan and the Mississippi Division of Medicaid (DOM)
  • Providing 30 days of emergency coverage to any TrueCare patient dismissed from the practice
  • Maintaining clinical records, including information about pharmaceuticals, referrals, inpatient history, etc.
  • Obtaining patient records from facilities visited by TrueCare patients for emergency or urgent care if notified of the visit
  • Ensuring demographic and practice information is up to date for directory and member use
  • Reporting suspected fraud and/or abuse
  • Providing “live voice” coverage after normal business hours which may include an answering service or shared-call system with other providers
  • Ensuring members’ telephone access to their PCP 24 hours a day, seven days a week

Cultural Competency 

Providers are expected to deliver services in a culturally competent manner, which includes removing all language barriers to service and accommodating the unique ethnic, cultural and social needs of the member. Providers must also meet the requirements of all applicable state and federal laws and regulations. For more information, check our Health Equity webpage .