Update to member discharges in 2019

Effective Jan. 1, 2019, we're implementing our updated policy to reduce your administrative burden and to protect our members from the continuous change of PCP re-assignments. The policy clarifies criteria for patients discharges, which are limited to instance of abuse:

  • Unpaid copayment or deductibles
  • Repeated no-shows
  • Threatening behavior
  • Doctor-shopping
  • Failed drug screen
  • Fraudulent behavior

We're also expanding our non-adherent member exclusions procedure.

This discharge process applies to members of all Priority Health products. As a reminder, PPO members are in an attribution model.

We're also working hard to move discharge requests online in 2019 to reduce your administrative burden.

Look for more details about these changes in the coming months.