Personal Choice/AHC

Personal Choice/Alabama Healthcare Council (AHC) is Blue Cross and Blue Shield of Alabama’s primary care network (PCN). This PCN is a managed care network committed to total quality care for our customers.

Be sure to read:

• Answers to Frequently Asked Questions
• Important Information Regarding Referrals

Each enrollee and eligible dependents select a Primary Care Physician (PCP) and all specialist care must be coordinated through PCP referrals. Following are the responsibilities and expectations of the PCP:

• Accessibility, availability, accountability in initiating the evaluative management process.
• Be the point of entry for the patient into the health care delivery system, providing the initial patient assessment and managing all aspects of patient care within the PCP scope of practice.
• Appropriate communication and follow up with referred to specialists.
• Act as the Health Care Resource Manager to ensure cost effective, medically necessary, quality health care through:
  • Preventive Benefits
  • Special Preferred Medical Doctor (PMD) review
  • Appropriate ER Referrals
• Provide for coverage, patient access and triage 24 hours a day, seven days a week. The following practices are unacceptable:
  • Answering machines or answering services that direct the patient to the emergency room after-hours
  • Making the patient decide whether the situation is a medical emergency or not
• Physician triage for acute/urgent conditions to prevent inappropriate emergency
  room utilization.
• Refer only to PMD providers. Requests for exceptions should be directed to the Primary Care Nurse Coordinator.
• Utilize PCN profile data and Primary Care Nurse Coordinator feedback to evaluate and maintain acceptable practice patterns for cost and utilization.
• Be available to meet with the PCN Nurse Coordinator when requested.
• PCP administrative staff must enter referrals into the Blue Cross and Blue Shield of Alabama system in a timely manner, no later than 72 hours from date of service. Retroactive referrals will only be allowed for PCP or staff error.