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Health Care Provider and Prenatal Care Coordination Agency
Prenatal care coordination (PNCC) is a service covered by Wisconsin Medicaid for all recipients. Successful provision of this service to individual recipients requires cooperation, coordination, and communication between the health care provider and the PNCC agency. The PNCC agency is responsible for outreach, risk assessment, care planning, care coordination, and follow up to support high-risk women. The health care provider is responsible for providing medically necessary services.
The health care provider and the PNCC provider agree to facilitate effective communication between agencies, work to resolve interagency coordination and communication problems, and inform staff from both the health care provider and the PNCC agency about the policies and procedures for this cooperation, coordination, and communication.
Recognizing that these "clients-in-common" are at high risk for poor birth outcomes, the health care provider and the PNCC provider agree to cooperate in removing access barriers, coordinating care, and providing culturally competent services.
This agreement becomes effective on the date the PNCC agency is certified by Wisconsin Medicaid or on the date when both the HMO and the PNCC agency have signed, whichever is later. It remains in effect until it is cancelled in writing with two weeks’ notice by either signer.
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Name of Health Care Provider or HMO
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Name of PNCC Agency
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| Authorizing Signature
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Authorizing Signature
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| Title
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Title
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| Date
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Date
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