Access Standards

Upper Peninsula Health Plan’s
Standards for Patient Access to Behavioral Health Care

As applicable, behavioral health care providers requesting participation with the Upper Peninsula Health Plan must meet or exceed the following standards for access by patients.

Care TypeDefinitionTelephone Access StandardsBehavioral Health Access Standards(Target Compliance)
RoutineNon-urgent care for symptomatic conditionsNot applicableInitial visit within 10
business days

Follow – up routine careVisits to evaluate patient progress and other changes that have taken place since a previous visitNot applicableWithin 30 days

UrgentNon-life-threatening conditions requiring urgent actionNot applicableWithin 48 hours

EmergencyNon-life-threatening condition demanding immediate actionNot applicableWithin 6 hours
Or
Directions to Emergency Room

Upper Peninsula Health Plan’s
Standards for Patient Access to Medical Care

As applicable, primary care providers (PCPs) requesting participating with the Upper Peninsula Health Plan must meet or exceed the following standards for access by patients.

Care TypeDefinitionTelephone Access Standards(Target Compliance)Medical Care Access Standards
(Target Compliance)
Regular & Routine CarePrevention and primary care for non-urgent conditions such as “well-child exams,” routine physical examinations, tests, and immunizations.Not applicable

Within 30 business days of request

Symptomatic,
Non-urgent
Problem related, however, condition is not urgentNot applicableWithin 7 days of request
UrgentNon-life-threatening condition requiring urgent actionNot applicableWithin 24 hours
After-HoursUrgent care for symptomatic conditions when the PCP office is closed

All PCP offices must have processes in place to provide instructions for obtaining care after-hours

 

24/7 Coverage
Within 24 hours to be seen for urgent care
Specialty care providers Not applicableWithin 6 weeks of request
Acute specialty care Not applicableWithin 5 business days of request

Page Last Updated: 07/12/2022