Patient Review and Coordination Program

Ensuring Safe Use of Services

Upon clinical review a member may be placed in our Patient Review and Coordination (PRC) program to better coordinate their care and make sure all services are utilized properly.

A member may be placed in the PRC program because of these factors:

• Getting care from several different doctors
• Having a high number of the same medications
• Using different pharmacies
• High emergency room use
• Care is not being coordinated

Members who are selected for PRC must choose one primary care provider, pharmacy, and hospital. If the member does not choose a provider, we will choose one for them. 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 two years as determined by state law (WAC) 182-501-0135.

If you are a provider and want to refer a patient to the PRC program or learn more, call us at 1-866-907-1902.