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 Type | Definition | Telephone Access Standards | Behavioral Health Access Standards(Target Compliance) |
| Routine | Non-urgent care for symptomatic conditions | Not applicable | Initial visit within 10 business days |
| Follow – up routine care | Visits to evaluate patient progress and other changes that have taken place since a previous visit | Not applicable | Within 30 days |
| Urgent | Non-life-threatening conditions requiring urgent action | Not applicable | Within 48 hours |
| Emergency | Non-life-threatening condition demanding immediate action | Not applicable | Within 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 Type | Definition | Telephone Access Standards(Target Compliance) | Medical Care Access Standards (Target Compliance) |
| Regular & Routine Care | Prevention 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 urgent | Not applicable | Within 7 days of request |
| Urgent | Non-life-threatening condition requiring urgent action | Not applicable | Within 24 hours |
| After-Hours | Urgent 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 applicable | Within 6 weeks of request | |
| Acute specialty care | Not applicable | Within 5 business days of request |
Page Last Updated: 07/12/2022