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Personal Choice Network
The Personal Choice Network 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 members.
Be sure to read:
Each member and all eligible dependents select a primary
care physician (PCP). All specialist care must be coordinated through
Responsibilities and expectations of the
- Accessibility and accountability in initiating the evaluative
- Point of entry for the patient into the healthcare 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.
- Healthcare Resource Manager to ensure cost-effective, medically
necessary, quality healthcare through:
- Preventive Care
- Appropriate Emergency Room Referrals
- Coverage, patient access and triage 24 hours a day, 7
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
- Physician triage for acute/urgent conditions to prevent inappropriate
- Referral to in-network providers only. Requests for exceptions should be directed
to Level III Review.
- Referrals entered by PCP administrative staff into the Blue Cross and
Blue Shield of Alabama system in a timely manner, no later than 72 hours
from the date of service. Retroactive referrals are only allowed for PCP
or staff error.