Updated discharge policy and new online discharge process

On Nov. 1, 2018, we announced our updated discharge policy would go into effect on Jan. 1, 2019. The updated policy is now available online.

The policy clarifies criteria for patient discharges, which are limited to instance of abuse:

  • Unpaid copayment of deductibles
  • Repeated no-shows
  • Threatening behavior
  • Doctor-shopping
  • Failed drug screen
  • Fraudulent behavior

In addition, for our PIP and CPC+ programs, non-adherent exclusions have been expanded to include failure to establish care and non-compliance.

We also shared we were working hard to move discharge requests online. We're happy to announce you are now able to enter discharges on Patient Profile to help reduce your administrative burden. To learn how to use Patient Profile for discharges visit Discharging a patient from care.

This discharge process applies to members of all Priority Health products. As a reminder, PPO members are attributed monthly based on their claims unless they have selected a PCP.

Note: We're no longer able to accept fax, email or paper forms for patient discharges.