Role and Responsibility of OB/GYN
Under this benefit, a female member age 12 and over may opt to have all her routine gynecological care, including her annual gynecological examination and Pap smear, as well as any other routine gynecological care performed by either her PCP or a participating gynecologist.
If the member elects to have her annual examination or other gynecologic-related services performed by a participating gynecologist, the protocol below must be followed:
- The member must use a participating OB/GYN from the MedStar Family Choice Specialist Network.
- No referral is necessary for visits which are annual, routine or for other gynecologic-related problems
- Following each visit for gynecological care, the OB/GYN must ensure clinical communication with the PCP concerning any diagnosis or treatment rendered.
- The OB/GYN must confer with the member's PCP prior to performing any diagnostic procedure that is not in the scope of routine office care.
The OB/GYN shall contact the member's PCP for all referrals for other specialty care (e.g., oncologist, neurologists, therapists, etc.).
Obstetrical Care For Normal OB Patients
Minimum Diagnostic Procedures: The initial diagnostic procedures may be done at the Primary Care Provider's office and the results forwarded to the OB physician. Note: A participating OB/GYN does not need a global OB referral to perform these services.
Upon confirmation of pregnancy, the Maryland Prenatal Risk Assessment must be completed and forwarded as required by the State. MSFC requests that providers also send a copy of this form to the MSFC Care Management Department. The fax number is (410) 933-2274. MSFC will review the assessment and contact the Member to offer appropriate services and referrals. Pregnant members who are less than 28 weeks pregnant will be offered membership into the Momma and Me Program. This Program provides many incentives for the Member to be compliant with pre-natal, post-partum, health education, and well-baby visits.
Minimum Diagnostic Procedures
- Antibody Screen ( Rh negative patients and Medical Assistance Patients)
- Blood Type
- Hepatitis B Surface Antigen
- HIV with Counseling and Consent (Should be noted if recommended and patient refuses)
- Rubella Screen
- Sickle Cell Screen for African-American women
- Testing for routine STDs- Chlamydia and GC
- Vaginal culture for Group B Strep at 34-37 weeks.
- Glucose challenge test (1ºGTT) Complete by 30 weeks for Medical Assistance patients)
- AFP - Alpha Feto Protein performed between 15 - 18 weeks.
- Hematocrit (and RPR for Medical Assistance patients) repeated by 36 weeks.
- Each visit should show evidence of urine screen for glucose and protein.
- In the Rho(d) negative patient, the Rh immune globulin (Rhig) 300 grams IM should be given at 28-32 weeks gestation, unless the father is Rh negative. (This is to be given in the OB provider's office
- Up to three sonograms - to be done in office or at an in-network MedStar Family Choice radiology facility. If the OB selects to use the in-network radiology facility, a Maryland Uniform Consultation Referral Form or script must be completed and sent to both the radiology facility and MSFC Care Management Department. Sonograms to be performed in regulated space require prior authorization. If more than 3 sonograms or additional testing/procedures need to be performed, authorization is required.
Note: All laboratory services must be sent to LabCorp. Please be sure to use a LabCorp Requisition form when sending a patient for lab services.
Initial assessment of pregnant and postpartum women and those requesting family planning services: 10 business days from request.
Frequency and Criteria of Office Visits should closely model the following schedule:
- Monthly for the first trimester
- Every 4 weeks through 32 weeks
- Every 2-3 weeks until 36 weeks
- Every week after 36 weeks
- Evidence of prenatal education to include: Diet, smoking and alcohol and drug usage
- Obstetrical history
- Family/social history
- Physical evaluation
- Genetic/birth defect screening with appropriate referrals and authorizations
Each subsequent visit:
- Evidence within the record of standard physical findings with appropriate diagnosis, treatment and follow-up for abnormalities including: fundal height and fetal heart rate
- Monitoring BP
- Identify high-risk patients and refer as necessary after approval from the PCP, i.e., nutritional counseling for gestational diabetes, etc.
- Monitoring weight
- HIV screening discussed, offered, and/or completed
- Substance abuse
- Post partum examination should be scheduled between 4 and 6 weeks after delivery. This should include a clearly documented family planning discussion (including patient's plans for birth control) and discharge back to PCP.
High Risk OB Patients
High-Risk care includes all the services outlined previously in "Obstetrical Care For Normal OB Patients". If any further diagnostic testing is required, it may need to be approved through Care Management at 1-800-905-1722, so that the care is coordinated and case managed, and/or proper referrals to ancillary services can be made. Please refer to the MSFC authorization requirements for information regarding OB services requiring prior authorization.
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