Behavioral health 24-hour access/on-call availability standards

All Priority Health contracted behavioral health providers are required to be accessible 24 hours per day, 7 days per week, 365 days per year. 

Acceptable accessibility techniques include:

  • An answering service that will contact the provider on behalf of the member.
  • An answering machine with explicit directions (including another telephone number if necessary) on how to each a provider and action to take in emergency. The provider may ask the member to leave a message but must be able to respond in an explicit manner.

Not acceptable:

Referral to local Community Mental Health for after-hour coverage, unless the individual provider has contractual arrangements for CMH payment.

Rural behavioral health providers

Rural providers (in Barry, Gratiot, Ionia, Mecosta, Montcalm, Newaygo, Oceana and Isabella counties) may direct members to the emergency room via an answering machine only if there is no participating provider in the same field of practice to share on-call coverage. The instructions must clearly direct members with non-emergent situations to call the emergency room first. The message should also provide the telephone number(s) of the emergency room(s) available in the area.

Determining compliance with accessibility standards

Individual circumstances will be taken into account, i.e. certain types of specialty practices.

At the time of the re-credentialing site visit, Priority Health will make after-hour phone calls to provider offices. If an answering machine directs the caller to leave a message, we may request the provider to call back to assess response time.

The determination of compliance, in unique or questionable circumstances, will be made by the Director of Behavioral Health as necessary.