SPECIALIST PHYSICIAN PARTICIPATION PLAN

Whereas the Memphis Medical Society and its physician members desire to provide physician services to low- income, uninsured residents of west Tennessee who cannot qualify for public health insurance and cannot afford private health insurance; and

Whereas the Project Access West Tennessee program has a referral system, in place since 2021, for equitably distributing uninsured, low-income patients enrolled in the PAWT program to physicians who agree to serve these patients free of charge;

Now therefore, I agree to participate in the Project Access West Tennessee program and agree to do the following as a participating physician:

• Accept up to my designated number per month, as resources allow, new patients who are low-income and uninsured persons referred by Project Access West Tennessee.

• My office will send a HCFA 1500 claim to the PAWT office at the Memphis Medical Society reporting theservices and charges for each Project Access patient visit.

 

I understand that the Memphis Medical Society make the following commitments to me regarding my participation in the program:

• The Memphis Medical Society will remain registered with the department of health as a sponsoring organization. Given that the provision of health care services by the participating physician is without charge to the recipient of the services or to a third party, the participating healthcare providers:

1. May satisfy one (1) hour of continuing education per one (1) hour of voluntary provision of healthcare services up to eight (8) hours.

2. Shall not be liable for any civil damages for any act or omission resulting from the rendering of such services, unless the act or omission was the result of such person's gross negligence or willful misconduct. Additionally, no contract of professional liability insurance covering a health care provider in this state, issued or renewed on or after May 26, 1995, shall exclude coverage to any provider who engages in the voluntary provision of health care services; provided, that the sponsoring organization and the health care provider comply with the requirements of this part.

 

• All patients referred by the Project Access West Tennessee office will have been previously treated by a primary care provider who has determined that a referral to a specialist is needed.

• All patients referred by the Project Access West Tennessee office will have been pre-screened for insurance coverage and found uninsured and ineligible for public insurance (TennCare

 

• All patients referred by the Project Access West Tennessee office will have documented their family income, and only those whose family income is at or below 200% of the federal poverty level will be eligible for referral to a participating physician.

 

• All patients referred by the Project Access West Tennessee office will receive a PAWT Specialty Care identification card that they will present when seeking services.

 

• The first appointment for each participant in Project Access West Tennessee will be scheduled by the Project Access West Tennessee office.

 

• The Project Access West Tennessee office will send a letter to the physician’s office confirming the appointment date and time and including information about the patient.

 

• Project Access West Tennessee patients will be referred to the next available participating physician on a rotating basis so that patients are distributed on an equitable basis.

 

1067 Cresthaven Rd, ● Memphis, TN 38119 Phone: 901-761-0200 ● Fax: 901-339-1276 projectaccess@mdmemphis.org

Option 1: I agree to see this patient through the Project Access West Tennessee program.

Option 2: I agree to see up to this number of new patients annually through the Project Access West Tennessee program.

1067 Cresthaven Rd, Memphis, TN 38119

Phone: 901-761-0200  

projectaccess@mdmemphis.org