Plan Benefits
Priority Partners offers programs and services to help members better manage their health. As Priority Partners HealthChoice members, your patients can take advantage of no and low cost services that include:
- Low-cost prescription drugs and over-the-counter medication. See the Priority Partners pharmacy and formulary for more information.
- Visits to urgent care centers
- Emergency department facility services
- Dental services: These services for children, pregnant women and adults are provided by the Maryland Healthy Smiles Dental Program, administered by Scion. Contact them at 855-934-9812 if you have questions about dental benefits. Dental services for adults were added to the Maryland Healthy Smiles Dental Program in 2023.
- Vision care: Vision care is provided by Superior Vision. Members can contact Superior Vision at 1-800-428-8789.
- HealthLink@hopkins: 24/7 secure online access to personal health information. Members can login or register at ppmco.org.
- Transportation to doctor and medical appointments: Members can call 1-800-654-9728 for transportation scheduling.
- Assistance in finding the appropriate health care services, as well as help with making doctor's appointments: Members can call 1-800-654-9728 for assistance and appointment scheduling.
- Care management: Members are placed in one of three levels, and depending on their level, are given a variety of support, tools and services that are specifically designed to help them better understand and manage their medical conditions.
- Health education: Priority Partners has a team of health educators that teach different programs to help members better manage their health. Members can call 1-800-957-9760 to sign up for a program or contact a health educator.
- Pregnancy Resources: Expectant moms have access to various programs including a high risk prenatal case management program. Members can call 1-800-261-2396 Ext. 5355 for more information.
Appointment Access Standards
| Service | Appointment Wait Time (not more than) |
|---|---|
| Initial Appointments | Members must be scheduled for an initial health appointment within ninety (90) days of enrollment unless one of the exceptions set forth in the HealthChoice Provider Manual applies. |
| Initial Prenatal Appointments | Initial prenatal appointments should occur (10) days from request, or from the date Priority Partners receives a Health Risk Assessment (HRA) for the new member, unless the member continues care with an established provider and the provider concludes that no initial appointment is necessary. |
| Family Planning Appointments | Ten (10) days from the date the member requests an appointment |
| High Risk Enrollee Appointments | Fifteen (15) days from request |
| Urgent Care Appointments | Forty-eight (48) hours from request |
| Routine, Preventive Care, or Specialty Care Appointments | Thirty (30) days from initial request, or, where applicable, from authorization from PCP |
| Initial Newborn Visits | Fourteen (14) days from date of discharge from hospital |
| Initial Newborn Visits if a Home Visit Has Been Provided | Thirty (30) days from date of discharge from hospital |
| Regular Optometry, Lab, or X-Ray Appointments | Thirty (30) days from date of request |
| Urgent Lab or X-Ray Appointments | Forty-eight (48) hours from date of request |
| Member Inquiry to Use Emergency Facility | Within Thirty (30) minutes |
| Office Visit | Waiting time to be seen may not exceed 1 hour after the scheduled appointment time |
Appointment Wait Time (not more than)
Fifteen (15) days from request
Waiting time to be seen may not exceed 1 hour after the scheduled appointment time