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Patient Review and Coordination (PRC) Program Description
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The Patient Review and Coordination (PRC) program is designed to help improve the
health and safety of CUP Healthy Options members who show high and/or incorrect
use of medical services, or show at-risk behavior.
When placed on this program, the CUP member will be limited to:
- One Primary Care Provider (PCP)
- One Pharmacy
- One Provider to prescribe all Controlled Substances
- And One Hospital for non-emergency services.
The Member will be allowed to choose providers (within the CUP network) if we receive
their choices within 10 days of the PRC placement notice.
The Primary Care Provider (PCP) can refer them to a specialist when it is necessary.
The member may have to pay for medical
services that they get from other providers without a referral from their PCP and
authorization from CUP.
This action does not affect the medical services for any other members
of their family.
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