PCP selection - Chapter 3, 2022 UnitedHealthcare Administrative Guide

Members in a gated plan1, and the open access products of Doctors Plan NexusACO OA and Select choose a network PCP at the time of their enrollment. If a PCP is not selected by a member, we assign one. A PCP is a physician in family practice, internal medicine, pediatrics, or general practice. Other specialties may be included if required by state law.

The PCPs designated by the member and enrolled dependent(s) do not need to be the same person or affiliated with the same group. The member and enrolled dependent(s) must select a PCP within the geographic area where the subscriber lives.

You can verify a member’s PCP when you verify their eligibility, as shown in the Verifying eligibility, benefits and your network participation status section in Chapter 2: Provider responsibilities and standards.

1 Subject to specific benefit designs.