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SPECIALIST AS PRIMARY CARE PHYSICIAN
In the event a new member upon enrollment, or a member upon diagnosis has a life-threatening condition or disease or a degenerative and disabling condition or disease, either of which requires specialized care over a prolonged period of time, they may request to elect an Atlantis Health Plan Specialist as their PCP. As the designated Specialist/PCP, you are responsible for providing and coordinating all of the member's primary and specialty care. You will be able to order tests, arrange procedures and provide referrals and medical services in the same capacity as a PCP.
To become a Specialist/PCP you must have the necessary qualifications and expertise to treat the member's condition or disease. This election will be permitted only if the Atlantis Health Plan Medical Director, after consulting with both you and the original PCP agree that the member's care would most appropriately be coordinated in this manner.
The Specialist, the original PCP and/or the member may call the Atlantis Utilization Management Department to make this request.
CONTINUITY OF CARE
Members receiving care from a provider leaving the network may continue an ongoing course of treatment with that provider during a transitional period.
The transitional period shall continue up to 90 days from the date of notice to the member or, if the member has entered the second trimester of pregnancy, for a transitional period that includes the provision of postpartum care directly related to the delivery.
Continuity of care will be authorized by Atlantis Health Plan if the provider signs an agreement accepting Atlantis Health Plan's established reimbursement at the rates as payment in full; adheres to Atlantis Health Plan's quality improvement requirements; provides medical information related to the care and adheres to Atlantis Health Plan's policies and procedures. Precertification by Atlantis Health Plan's Utilization Department is required.
Please Note: Continuity of care covers those services contained in the subscriber contract and is subject to the described limitations.