USAble Administrators

Primary Care Network (PCN)

The Primary Care Network (PCN) is an employer-sponsored, managed care program available through USAble Administrators, which can be integrated into the specific benefit plan and funding arrangement of a self-funded employer group. Primary care physicians (PCPs) serve as "patient managers" to appropriately manage secondary and tertiary referrals (specialty care) with the expectation that unnecessary treatment and hospitalization can be limited. The PCN is offered as an option to a standard medical plan or other managed care programs for the employee's health-care coverage.

Health-Care Cost Management

The PCN encourages use of health-care services in the most efficient and cost-effective setting. To manage health-care costs, the PCN limits patient self-referrals by enforcing referrals controlled by the employee-selected PCP.

Primary Care Physician Selection

To participate in a PCN, each member must select a primary care physician (PCP). Members must choose from physicians authorized to participate in their particular network.

If you are a PCN member, contact your employer for a listing of PCPs who participate in your network. You may change your PCP selection by completing a change form, which is available from your employer's group administrator. Consult the group administrator to find out how often you may change your PCP selection.

Every primary care physician is required to have a backup. If your PCP is not available, request services from the backup physician.

Referrals to Specialty Care

In addition to the PCN, your plan may access a specific network of providers for referred services (specialty care). As an example, you may have a PCN/PPO plan. That means that if your PCP refers you for specialty care, the referral must be to a Preferred Provider Organization (PPO) provider for you to receive the highest level of specialty benefits. The specialist must participate in the PPO network.

For more information, see Referral Process for Primary Care Network (PCN).