The Centers for Medicare and Medicaid Services (CMS) sets appointment wait-time standards for provider offices, and CMS monitors providers for adherence to these requirements through secret shopper surveys. It’s crucial for provider offices to structure their schedules to allow for new appointments to be scheduled in a timely manner.
Availability standards
Check and familiarize yourself with the provider availability standards in our Provider Manual. Remember that by being in Priority Health’s network you are contractually obligated to meet these standards.
Tips on meeting availability standards
- Leave protected appointment slots: Reserve some appointment slots each day, week or month so pre-scheduled visits don’t fill all available capacity. Then schedule patients into these slots upon request within availability standard windows.
- Use hold-and-release scheduling: Hold certain appointment slots for new patients, sick visits, hospital follow-ups etc., then release any unused slots to established patients closer to the appointment date to avoid wasted capacity.
Check your network participation status
Make sure you’re not turning away any members for whom you’re in network. Search your practice on our Find A Doctor tool and click the hyperlink under Plans accepted to see all plans you’re in-network for.
Remember: Medicare providers are required to see our dual-eligible members. This includes PriorityMedicare D-SNP and PriorityMedicare Dual Premier. Dual Premier is Priority Health’s Highly Integrated Dual-Eligible Special Needs Plan (HIDE-SNP), which is part of Michigan’s MI Coordinated Health (MICH) program. Members and patients may refer to their coverage as “Dual Premier”, “HIDE” or “MICH”. Find more information, including benefit coverage, on our Provider Manual.
Changing your network participation status
Change your network participation status in prism:
- Log into your prism account
- Click Enrollments & Changes
- Click In-network provider change
- Select Provider Change and click Next
- Select the appropriate Product changes option and click Next
- Follow the instructions on the screen and fill in all requested information
PCPs may also close to new patients, when necessary. Specialists (non-PCPs) remain open to new patients unless they update their open/closed status via prism.
Updating your information
See our Provider Manual for making changes to your information, including practice name, staff, address, phone number(s), etc.
Staff training
Please review the information above with all current staff who schedule appointments, including front desk, registration, and scheduling.
Provider offices should also establish a process to ensure new staff are educated on PriorityMedicare Dual Premier as part of onboarding or before scheduling appointments. This will help maintain continuity when staffing changes occur. Be sure to take the following required provider office/practice actions:
- Educate all current appointment-scheduling staff on PriorityMedicare Dual Premier’s plan name and benefit coverage.
- Ensure scheduling staff know how to recognize PriorityMedicare Dual Premier members and appropriately assist with appointment scheduling.
- Incorporate PriorityMedicare Dual Premier education into the onboarding/training process for new scheduling staff.
- Maintain an internal process to ensure education continues when staff turnover occurs.
- Retain documentation of staff education according to your office’s normal training documentation practices.
Please share this information with your office manager, practice manager and all staff involved in appointment scheduling.