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Plan Benefits

Priority Partners offers programs and services to help members better manage their health. As Priority Partners HealthChoice members, your patients can take advantage of no and low cost services that include: 

  • Low-cost prescription drugs and over-the-counter medication. See the Priority Partners pharmacy and formulary for more information.
  • Visits to urgent care centers
  • Emergency department facility services
  • Dental care: Dental care for pregnant women and children is directly provided by the Maryland Healthy Smiles Dental Program. Members can contact DentaQuest directly at 1-888-696-9596. For adults 21 and over, dental care is provided by Priority Partners through DentaQuest. Members can contact DentaQuest at 1-800-698-9611.
  • Vision care: Vision care is provided by Superior Vision. Members can contact Superior Vision at 1-800-428-8789.
  • HealthLink@hopkins: 24/7 secure online access to personal health information. Members can login or register at ppmco.org.
  • Transportation to doctor and medical appointments: Members can call 1-800-654-9728 for transportation scheduling.
  • Assistance in finding the appropriate health care services, as well as help with making doctor's appointments: Members can call 1-800-654-9728 for assistance and appointment scheduling.
  • Care management: Members are placed in one of three levels, and depending on their level, are given a variety of support, tools and services that are specifically designed to help them better understand and manage their medical conditions.
  • Health education: Priority Partners has a team of health educators that teach different programs to help members better manage their health. Members can call 1-800-957-9760 to sign up for a program or contact a health educator.
  • Pregnancy Resources: Expectant moms have access to various programs including Partners with Mom a high risk prenatal case management program and health coaching. Members can call 1-800-261-2396 Ext. 5355 for more information.

Appointment Access Standards

ServiceAppointment Wait Time (not more than)
Initial AppointmentsMembers must be scheduled for an initial health appointment within ninety (90) days of enrollment unless one of the exceptions set forth in the HealthChoice Provider Manual applies.
Initial Prenatal AppointmentsInitial prenatal appointments should occur (10) days from request, or from the date Priority Partners receives a Health Risk Assessment (HRA) for the new member, unless the member continues care with an established provider and the provider concludes that no initial appointment is necessary.
Family Planning AppointmentsTen (10) days from the date the member requests an appointment
High Risk Enrollee AppointmentsFifteen (15) days from request
Urgent Care AppointmentsForty-eight (48) hours from request
Routine, Preventive Care, or Specialty Care AppointmentsThirty (30) days from initial request, or, where applicable, from authorization from PCP
Initial Newborn VisitsFourteen (14) days from date of discharge from hospital
Initial Newborn Visits if a Home Visit Has Been ProvidedThirty (30) days from date of discharge from hospital
Regular Optometry, Lab, or X-Ray AppointmentsThirty (30) days from date of request
Urgent Lab or X-Ray AppointmentsForty-eight (48) hours from date of request
Member Inquiry to Use Emergency FacilityWithin Thirty (30) minutes
Office VisitWaiting time to be seen may not exceed 1 hour after the scheduled appointment time
Appointment Wait Time (not more than)

Fifteen (15) days from request
Waiting time to be seen may not exceed 1 hour after the scheduled appointment time