Provider Services

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Provider Services

PCAP links low-income, uninsured residents of Pima County with an affordable, comprehensive and coordinated network of health care providers.

Primary Care Doctors

  • Members pay 100% of Medicare Allowable at time of service

Specialists

  • Members pay $30 per office visit at time of service for Evaluation and Management CPT codes
  • Members pay 35% of Medicare Allowable for all other CPT codes
  • Members pay 50% of Medicare Allowable for Surgical codes

Services available to contracted providers

  • Initial and on-going education regarding PCAP
  • Verify member eligibility
  • Assistance with collection efforts in the event that member does not pay provider directly
    • Contact members to discuss non-payment
    • 15-day late letter sent to member indicating failure to pay will result in termination from PCAP
  • Assistance with notifying members who fail to show for appointments
  • Ensure members comply with Members Responsibilities
  • Work with providers to monitor member volume

Claims/Encounter Data

  • Providers should submit claims and encounter data for all member visits on a regular basis
  • Encounter data is reviewed by PCAP to monitor network adequacy and healthcare trends

Referrals

  • Member must present referral from PCP prior to seeing specialist
  • Providers must refer members to an in-network provider unless specialty is not available in the network. Referral to an out of network provider would result in higher out of pocket costs for the member

Providers must submit lab work to Sonora Quest. Sonora Quest is the exclusive lab provider and the member would be responsible for higher out of pocket costs if an out of network provider is utilized.

Exclusions

  • Dental Services
  • Obstetrical Services
  • Emergency Room Services (only covered if admitted; in-patient fees will then apply)
  • Emergency Room Physician
  • Ambulance

This list is not all inclusive. Please contact Provider Development Team at numbers listed below for additional information.

If you need to reach the PCAP Provider Development team please call the PCAP main line.
PCAP main line – 520-694-0418
PCAP Fax – (520) 309-2934

Important Phone Numbers
2016 Important Phone Numbers (PDF)
2016 Numeros Importantes (PDF)

2016 Provider Network Roster (PDF)

Primary Care Physicians – Non-clinic – Current (PDF)