Our Patient Review and Coordination (PRC) Program helps members use their medical services safely and appropriately.
Some members get care from several different doctors. They have a high number of the same medications. They use different pharmacies. They use the emergency room a lot. Sometimes the care is not coordinated and can be dangerous. Sometimes we place these people in PRC because of these factors.
Members who are selected for PRC must choose one primary care provider, pharmacy, and hospital. If the member does not choose providers, we will choose them for the member. Members in PRC must go to these providers only. If a member in PRC goes to any other provider without a referral, the member must pay for the service.
One primary care provider makes sure medical care and prescriptions are coordinated for the health and safety of the member. PRC makes this possible. Members stay in the PRC program for at least 2 years as determined by state law.
To learn more, call us at 1-800-440-1561 (TTY Relay: Dial 711), Monday through Friday, 8 a.m. to 5 p.m.