Personal Choice Network
The Personal Choice Network (PCN) is Blue Cross and Blue Shield of Alabama's primary care network. PCN is committed to total quality care for our members.
Be sure to read:
Each member and all eligible dependents select a primary care physician (PCP) and all specialist care must be coordinated through PCP referrals.
Responsibilities and expectations of the PCP include:
- Accessibility and accountability in initiating the evaluative management process.
- 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's 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 or not
- Physician triage for acute/urgent conditions to prevent inappropriate emergency room utilization.
- Referral to in-network providers only. Requests for exceptions should be directed to Level III Review.
- Referrals entered by PCP's 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.