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IMPORTANT: PCP Change Requests

Date: 02/18/26

All Primary Care Provider (PCP) changes, and provider-initiated transfer requests must be handled in accordance with Federal and State regulations, health plan requirements, and company standards. Providers must follow the documentation process and submit all required forms along with the necessary documentation. As a reminder, members must not be reassigned for discriminatory reasons or based on cost of care.

Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS) and CHIP

  • Superior HealthPlan may reassign a member to another PCP.
  • Providers may request reassignment but must first take reasonable steps to address member behavior.
  • If resolution fails, the Superior will notify the member of the reassignment.
  • Providers should also notify the member in writing and send a copy to the Superior.
  • Effective Date Rule: PCP changes may be effective immediately upon processing, per HHSC guidelines.

Wellcare and Wellcare By Allwell

  • Members may self-select or change their PCP based on plan rules and network availability.
  • PCP change requests must be processed timely and follow the “10th of the month” rule:
    • Requests received by the 10th are effective from the 1st of the same month.
    • Requests received after the 10th are effective the 1st of the following month.
  • For provider-initiated reassignment providers must:
    • Follow all contractual and regulatory obligations.
    • Provide notice to the member.
    • Allow the members to select a new PCP.
    • Ensure continued access to medically necessary services during the transition.

Required Forms

PCP Change Request (Voluntary) – Member-initiated Reassignment

  • The PCP Change Request Form can be found under the Other Provider Forms section of the Wellcare Forms webpage.

PCP Transfer Request (Involuntary) – Provider-initiated removal with documentation showing reasonable efforts to retain the member

  • The PCP Request for Transfer of Member Form can be found under the Other Provider Forms section of the Wellcare Forms webpage.

If you have any questions, contact your Provider Representative. To find their contact information please visit the Find My Provider Representative webpage.