Priority Health Choice Inc. Transition of Care

What is Transition of Care?

If you're new to Priority Health Medicaid and your provider or medication is not covered, Transition of Care may allow you to temporarily continue receiving care.

Members, their appointed representative, or providers may request Transition of Care authorizations. Transition of Care requests are meant to temporarily continue coverage of services for members within the first 90 days of eligibility whose health would be put at serious risk if they go without care.

Transition of Care applies to two very specific needs

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    Out-of-network providers

    With Transition of Care, you may be able to continue to receive services from health care providers who are not in your plan’s network. You must be established with the out-of-network provider, having seen them in the past 6 months. 

    Not sure if your provider is in-network?

    Use our Find A Doctor tool to search for your provider.

    Find A Doctor

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    If you are taking a drug that is not covered or has restrictions, a Transition of Care authorization may temporarily provide continued coverage. You must have been previously approved or be established on the medication to qualify. 

    Not sure if your drug is covered? 

    Use the Approved Drug List to search for your drug.

    Approved Drug List

Before you request a Transition of Care authorization

Remember, the member must be:

  • Within the first 90 days of eligibility with Priority Health Medicaid
  • Established with the provider or on the medication
  • At serious risk if they go without care

Request a Transition of Care authorization

Authorizations may be submitted online or by calling Customer Service. 

Start submission process

You must submit one request per out-of-network provider or medication. Once a request is submitted, Priority Health has 3 business days to review and make a decision.