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PCP Verification

Updated on April 26, 2021

The PCP verification collection facilitates the execution of the IsPCPRequired decision table, which is used to configure a PCP-only condition for services, based on the presence of certain plans and/or networks.

When the condition = true, all services must be delivered by the member’s PCP of record. This feature is used for testing purposes in the absence of a PCP-only indicator at the benefit level. For a more in-depth discussion on unsolicited provider matching, see Chapter 22, Provider eligibility.

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