Coverage Arrangements

All participating practitioners must ensure 24-hour, 7 day-a-week coverage for members.  Coverage arrangements should be made with another Gateway participating practitioner or practitioners who have otherwise been approved by Gateway.  When a participating primary care practitioner has arranged, on a permanent basis, cross coverage arrangements with another participating primary care practitioner, the primary care practitioner should contact his Provider Relations Representative to set up a Provider Association between the two practitioners.  All encounters must be billed under the name of the rendering practitioner, not the member’s assigned primary care practitioner.    Reimbursement will be paid directly to the participating covering primary care practitioner.

Covering practitioners, whether participating or not, must adhere to all of Gateway’s administrative requirements.  Additionally, covering practitioners must agree not to bill the member for any covered services.  The covering practitioner should report all calls and services provided to the member’s primary care practitioner. To request approval of a non-participating covering practitioner, the participating practitioner must submit a request to Gateway’s Medical Director with a signed On-Call Practitioner Coverage Agreement, found in the Forms and Reference Materials Section of this Manual.  All encounters must be billed under the name of the rendering practitioner, accompanied by a copy of the Coverage Agreement.  Reimbursements will be paid directly to the covering practitioner.  Participating practitioners will be held responsible for the actions of their nonparticipating coverage practitioners.

Primary care practitioners agree that, in their absence, timely scheduling of appointments for members shall be maintained.