Patient Attribution Hierarchy
A hierarchy is used to attribute health plan members to a physician. If a member has a managed care product (HMO, POS) that requires the selection of a Primary Care Physician (PCP), the member will be attributed to his/her enrollment PCP regardless of the number of visits the member has with his/her PCP, as of the last day of the reporting time frame.
If a member does not have a PCP, the member will be attributed to the Imputed PCP based on evaluation and management (E&M) visits.
The Attribution Hierarchy is:
1) Enrollment PCP (Enrollment data only; regardless of claims).
2) Imputed PCP (E&M visits based on claim information).
3) Imputed Specialist (E&M visits based on claim information).
If a member does not have a PCP, the member will be attributed to the Imputed PCP based on evaluation and management (E&M) visits.
The Attribution Hierarchy is:
1) Enrollment PCP (Enrollment data only; regardless of claims).
2) Imputed PCP (E&M visits based on claim information).
3) Imputed Specialist (E&M visits based on claim information).