Patient Attribution Hierarchy
A hierarchy is used to attribute health plan members to a physician. If a member has selected a Primary Care Physician (PCP) as of the last day of the reporting timeframe, the member will be attributed to his/her enrollment PCP regardless of the number of visits the member has with his/her PCP. If a PCP was not selected as of the last day of the reporting period, the member will be attributed to the Imputed PCP.
The Hierarchy is as follows:
The Hierarchy is as follows:
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)
2) Imputed PCP (E&M visits based on claim information)
3) Imputed Specialist (E&M visits based on claim information)