Discharging a patient
Priority Health expects that providers will not discriminate against members because of race, color, ancestry, religion, age, sex, national origin, marital status, health status or disability.
- Member discharge requests are subject to review by Priority Health.
- The discharge request policy applies to all products.
- CMS and State of Michigan Medicaid program guidelines may override portions of this policy for Medicare and Medicaid members.
Discharge letter & form standards
- You must send each discharged patient a letter explaining the reason(s) you are discharging him/her.
- Complete a Patient Discharge Form (42KB PDF) to request all discharges, including non-established care transfers and transfers of records. Attach a copy of the discharge letter you sent the patient.
Coverage after discharge
After discharge, you must provide 30 days of urgent/emergent care to the discharged patient.
Unacceptable criteria for discharge
- Discharge is related to incentive program rewards
- Member is using the alternate benefit under POS plans
- Member is seeing participating specialists as part of the open network policy
- Member is seeking services from a participating primary care provider not in your practice. You cannot discharge the member, the member must contact Customer Service to update their PCP assignment.
Acceptable criteria for discharge
Causes for immediate discharge:
- Outstanding unpaid balance or balance in collections, including copayment, coinsurance, and deductible
- Repeated no-shows for appointments or consistent lateness for appointments
- Disruptive or abusive behavior toward staff, fellow patients or physician
- Previously discharged from the practice prior to the patient's effective date with Priority Health
- Repeated failure to follow physician recommendations for care
- "Doctor shopping" to obtain prescriptions, such as narcotics
- Fraud
Cause for discharge after failure to establish care:
"Failure to establish care" is defined as making three documented attempts to reach the member with no response.
- Attempts can be letters or calls requesting the member establish care by scheduling an appointment within a set time frame.
- These documented attempts must span a minimum of 90 days.
