Primary Care Provider Data

Primary Care Provider (PCP) information is often required by carriers for enrollment in medical and dental HMO plans. These plans route all care through a single primary care provider, and carriers sometimes require details of that provider before they will issue coverage.

Please note that some carriers do not accept changes to PCP data sent by the employer group following initial enrollment, and instead require all PCP changes to be submitted by the member directly. In these cases, you can still send PCP information to Noyo but the data will not be updated in the carrier’s system.

If you are managing groups with HMO plans through Noyo, be sure to check carrier-specific documentation in the Command Center for additional requirements around PCP information. In general, it’s a best practice to provide PCP information for members enrolled in these plans whenever it’s available.

When needed, PCP data can be sent in the primary_care_providers block as shown below. See the full details of PCP data payloads in the Member Snapshot API Reference.

"primary_care_providers": [
	{
	 "entity_identifier_code": "PCP",
	 "entity_type": "person",
	 "identification_code_type": "NPI",
	 "identification_code": "1234567890",
	 "last_name_org": "McCoy",
	 "first_name": "Leonard",
	 "middle_name": "H",
	 "patient_relationship_code": "unknown"
	}
]