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 | Within 10 working days
(80%) |
| Urgent | Non-life-threatening conditions requiring urgent action | Not applicable | Within 48 hours
(80%) |
| Emergency | Non-life-threatening condition demanding immediate action | Not applicable | Within 6 hours – or – directions given to emergency room
(80%) |
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 and Routine | Prevention and primary care for non-urgent conditions (such as well-care exams, routine physical exams, tests, and immunizations) | Not applicable | Child 0-17: Within 4 weeks
Adult 18+: Within 5 weeks for an initial appointment (80%) |
| Urgent | Non-life-threatening condition requiring urgent action | Not applicable | Within 48 hours
(80%) |
| 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
(80%) |
Coverage 24 hours per day, 7 days per week
Within 48 hours to be seen for urgent care (80%) |
Page Last Updated: 09/26/2018