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 /Appointment | Definition | Length of Time |
|---|---|---|
| Emergency Services | Covered services needed to evaluate or stabilize a member’s emergency medical condition | Immediately; 24 hours/day 7 days/week |
| Urgent Care | Medical 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 treatment | Within 48 hours |
| Routine Care | A 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 Symptomatic | A member encounter with a Provider that is associated with presenting medical signs and symptoms, but that does not require urgent or immediate medical attention | Within 7 business days of request |
| Specialty Care | Covered services generally proved by Specialist Physicians in their field of training and experience | Within 6 weeks of request |
| Acute Specialty Care | Non-life-threatening condition requiring urgent action | Within 5 business days of request |
| Behavioral Health Routine Care | Non-urgent for symptomatic conditions | Within 10 business days of request |
| Behavioral Health Non-life-threatening emergency | Non-life threatening requiring immediate action | Within 6 hours of request or directions to the emergency department (ED) |
| Behavioral Health Urgent Care | Non-life threatening condition requiring urgent action | Within 48 hours of request |
| Urgent Dental Care | Services required to prevent serious deterioration of oral health following the onset of an unforeseen condition or injury. | Within 48 hours |
| Routine Dental Care | Dental 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 Appointment | The first dental appointment for a new patient. | Within 8 weeks of request |
Questions? Please contact UPHP Provider Relations at:
uphpproviderrelations@uphp.com or 906-226-4285
Page Last Updated: 11/9/2022