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 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 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 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. See Health Programs for Members for more information.
- Health education: Priority Partners has a team of health educators that teach different programs to help members better manage their health. Members can call 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 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