Welcome patients! This page contains helpful resources for managing your health and navigating managed care. As always, feel free to contact us if you have questions or concerns.
Member Rights and Responsibilities
Members have the right to be represented by parents, guardians, family members or other conservators for those who are unable to fully participate in their treatment decisions.
Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Language Assistance Program Contacts
The Health Care Language Assistance Act requires insurers to establish and support language assistance programs for certain residents who have limited English proficiency. This link provides important contacts by health plan for these programs.
Advanced Health Care Directive
By creating an Advanced Health Care Directive you can let your physician, family, and friends know your health care preferences, so in the event that you become incapacitated, you can ensure that decisions are made according to your will. The forms below offer a guide to creating your Advanced Health Care Directive. If necessary, take time to speak with your healthcare professional.
Local Wellness Center
We have compassionate warm Member service staff to address your questions and concerns. Come by and say Hi and enjoy the daily wellness activities offered. Our business hours are Monday through Friday, 9:00a.m. to 5:00p.m. Our Member Service number is 442-231-8101.
Affirmative Statement
As a utilization management organization, Premier Patient Care IPA, ensures that all decisions are made based on the available medical information at the time of the request. Should a member ask to see the criteria utilized to make a medical decision; the statement below is attached to that guideline, as required by the National Committee for Quality Assurance (NCQA):
Decisions regarding requests for medical care are based on the medical necessity of the request, the appropriateness of care and service and existence of coverage. There is no monetary reward for non-approval of services. Compensation for individuals who provide utilization review services does not contain incentives, direct or indirect, for these individuals to make inappropriate review decisions.
Utilization review criteria, based on reasonable medical evidence and acceptable medical standards of practice (i.e. MCG and/or applicable health plan guidelines) are used to make decisions pertaining to the utilization of services. Review Criteria are used in conjunction with the application of professional medical judgment, which considers the needs of the individual patient and characteristics of the local delivery system. A copy of the Medical Criteria guidelines can be delivered upon request by emailing support@procaremso.com or by telephone at 657-206-8700.