The Alliance has updated our process for primary care providers (PCPs) to request member reassignment to a new PCP. Note: this process is only for linked Alliance members.
Please review the following highlights of our member reassignment policy and process. For more details, see:
Member Reassignment Threshold
Providers should be aware of the Member Reassignment Threshold, which is a Care-Based Incentive (CBI) measure.
The Member Reassignment Threshold is a maximum of one reassignment per 150 linked members. PCPs who exceed one reassignment per year per average 150 linked members are at risk of losing half of their CBI programmatic payments.
The Member Reassignment Threshold is not applied if the CBI provider has either:
- Less than an average of 100 eligible members, as determined by the number of months for which the CBI provider was contracted during the measurement period.
- Less than 100 eligible members as of the end of the CBI calendar year.
Reassignment reasons that do not impact CBI
- Alleged/actual fraud or theft.
- Alleged abusive/disruptive behavior.
- Violation of medication management agreement.
- Members aging out of current PCP practice.
- Member-initiated request for different PCP.
- Non-Medi-Cal member reassignments.
Additional reasons that can be considered for no impact to CBI
If the member has already been referred to/is working with PCP case management, Alliance Case Management or an Enhanced Care Management (ECM) provider, then the following reasons for reassignment can be considered for no impact to CBI:
- Request for non-medically necessary orders.
- Non-compliance with treatment plan.
- Ineffective relationship.
- Failure to keep appointment.
Member Reassignment Request from multiple sites
When a provider has multiple sites under one contract, the Alliance’s approval of member reassignment from one site does not prevent reassignment to any of the provider’s other sites.
The Alliance will first explore PCP options outside the provider’s sites.
If there are no available open panel providers that meet California Code WIC §14197 requirements, then the member may be offered reassignment to a different site location within the same original provider group to ensure that the member retains access to health care services.
Care Management referral
Before requesting member reassignment, providers should submit a care management referral as the first step to support early intervention.
Questions?
If you have any questions about member reassignments, please contact your Provider Relations Representative at 800-700-3874, ext. 5504.
