What are my responsibilities as a HMO provider?
Physician/health care provider roles and responsibilities differ among the various specialties; however, certain responsibilities will be shared by all HMO-contracted physicians and providers. The responsibilities of HMO-contracted physicians/providers include, but are not limited to the following: • Providing and coordinating health care for the enrollee. – Contracted primary care physicians (PCP’s) are responsible for managing the enrollee’s primary, preventative, acute and chronic health care needs, for initiating specialist referrals and for obtaining any required pre-authorizations. – Contracted referral specialists are responsible for providing covered health care services to the enrollee and for ensuring that any required referrals have been obtained. • Hold Harmless clause in contract. – A HMO physician/provider contract must include a statement that the physician/provider will not bill the enrollee for payment of the cost of covered health care services (hold harmless), if the
