Are you in our Medicare network? If so, you're required to see our dual-eligible members (D-SNP and Dual Premier) even if you’re not in our Medicaid network.
What are dual-eligible members?
Dual-eligible members are members who qualify for both Medicare and Medicaid. We have two dual-eligible plans:
- PriorityMedicare D-SNP (in-network for Medicare providers)
- PriorityMedicare Dual Premier (in-network for Medicare and Medicaid providers)
What if the member has Medicaid as their secondary coverage?
Medicare providers are still required to see dual-eligible members, even if the member has Medicaid as their secondary coverage. Remember: Dual-eligible plans are Medicare plans.
How do I check what plan a member has using prism?
Use prism’s Member Inquiry to see a member’s plan. After searching for a member, PriorityMedicare D-SNP or PriorityMedicare Dual Premier will be listed in the Plan Type field.
Is there to way to check if a specific provider is in-network for D-SNP or Dual Premier?
Yes, our Find A Doctor tool allows you to search for specific providers and see the plans accepted by that provider or practice. With a provider selected, click the hyperlink in the Plans accepted field to see if PriorityMedicare Dual Premier and PriorityHealth Medicare and D-SNP are listed in the Medicare and Dual Eligible Special Needs (D-SNP) Plans dropdown.
We encourage you to use Find A Doctor to search for yourself and/or your own practice to verify which plans you should be accepting.