Access Standards

Timely Access to Care

UPHP requires network providers to meet Michigan Department of Health and Human Services (MDHHS) standards for timely access to care and services as shown below.  Network providers must have office visits available during regular and scheduled office hours.  UPHP will include hours and locations of service for network providers via the provider directory and requires network providers offer hours of operation that are no less than the hours of operation offered to commercial enrollees, or hours of operation comparable to Medicaid Fee for Service, if the Provider serves only Medicaid enrollees.

Type of Care /AppointmentDefinitionLength of Time
Emergency ServicesCovered services needed to evaluate or stabilize a member’s emergency medical conditionImmediately; 24 hours/day 7 days/week
Urgent CareMedical care provided for a condition that without timely treatment, could be expected to deteriorate into an emergency, or cause prolonged, temporary impairment in one or more bodily function, or cause the development of a chronic illness or need for a more complex treatmentWithin 48 hours
Routine CareA member encounter that is not associated with any presenting medical signs. Examples include well-child and annual adult physical examinations. Within 30 business days of request
Non-urgent SymptomaticA member encounter with a Provider that is associated with presenting medical signs and symptoms, but that does not require urgent or immediate medical attentionWithin 7 business days of request
Specialty CareCovered services generally proved by Specialist Physicians in their field of training and experienceWithin 6 weeks of request
Acute Specialty CareNon-life-threatening condition requiring urgent actionWithin 5 business days of request
Behavioral Health Routine CareNon-urgent for symptomatic conditionsWithin 10 business days of request
Behavioral Health Non-life-threatening emergencyNon-life threatening requiring immediate actionWithin 6 hours of request or directions to the emergency department (ED)
Behavioral Health Urgent CareNon-life threatening condition requiring urgent actionWithin 48 hours of request
Urgent Dental CareServices required to prevent serious deterioration of oral health following the onset of an unforeseen condition or injury.Within 48 hours
Routine Dental CareDental services that include the diagnosis and treatment of oral health conditions to prevent deterioration to a more severe level or minimize/reduce the risk of development of dental disease or the need for more complex dental treatment. Examples include but are not limited to services such as fillings and space maintainers.Within 21 business days
Preventive Dental Services Preventive dental services include services such as oral evaluations, routine cleanings, x-rays, sealants, and fluoride treatments.Within 6 weeks of request
Initial Dental AppointmentThe first dental appointment for a new patient. Within 8 weeks of request

Questions?  Please contact UPHP Provider Relations at: or 906-226-4285

Page Last Updated: 11/9/2022