Answers to your questions
Click on some of the most frequently asked questions below to find the answer. For additional questions, contact our customer service department at 800-654-9728.
How do I enroll with a Managed Care Organization (MCO)?
My benefits have been terminated. How do I re-enroll?
Is my newborn automatically enrolled?
How do I get a replacement identification (ID) card?
How do I change my Primary Care Physician (PCP)?
How do I obtain a listing of PCPs and Specialists that participate with Priority Partners?
Who or where do I call for eye/vision care?
Who or where do I call for dental care?
Who or where do I call for mental health or substance abuse participating providers?
How long does it take for my insurance to become effective?
Do I need to contact Priority Partners prior to going to the emergency room?
What is a Preauthorization?
What is a Referral?
What is a Site of Service?
How do I find out more information about medication preauthorization?
If I pay the full price for a prescription will Priority Partners reimburse me?
How can I obtain a nebulizer?
When do I call Priority Partners Customer Service?
Where can I find an urgent care center?
How do I claim my preventive care visit gift card?
Participants can enroll in an MCO and pick their primary care provider (PCP) after they receive information from the enrollment broker about each MCO with directions about how to enroll in an MCO and select their PCP. Contact Maryland Health Connection at 855-642-8572 (TTY: 855-642-8573).
Here’s how you can reapply for your health benefits:
- Online at Maryland Health Connection – Create a user account, then go to “Start New Application” from the Quick Links on the Account Home page
- By calling the Maryland Health Connection Call Center at 855-642-8572
- In-person at your local Health Department, or local Department of Social Services.
Yes, if mother is a Priority Partners member on the newborn’s date of birth.
No, if mother is a member of a different MCO on the newborn’s date of birth.
No, if mother has no MCO or MA coverage on the newborn’s date of birth. In this case their mother should contact local Department of Social Services. Click here for a list of Social Services offices in each county.
You can change your PCP by logging into your HealthLink@Hopkins account or you can also
Contact Priority Partners at 800-654-9728. Your approved PCP change will become effective the day Priority Partners is notified.
For Pregnant Women and Children
Dental care is directly provided by the Maryland Healthy Smiles Dental Program. Contact Scion at 855-934-9812 or visit the SkygenUSA Dental website for more information or to find a dentist.
For Adults 21 and Over
Dental care is provided by Priority Partners through DentaQuest. Contact DentaQuest at 800-698-9611 or visit the DentaQuest Dental website for more information or to find a dentist.
If you have a substance abuse or mental health question or concern, or need to be directed to treatment options, please call Optum Maryland at 800-888-1965, TTY 711, and they will be happy to assist you.
Each application is reviewed individually so it’s difficult to predict a specific timeline. The Department of Health and Mental Hygiene strives to process them within days of receiving the application. Check back with the local Health Department or Department of Social Services where you applied. They will be responsible for processing and approving your application. Once your application is approved you have 28 days to select one of the HealthChoice MCOs to provide your health benefits. Services become available 10 days after you choose an MCO.
No. For life threatening emergencies contact or dial 911 and then call your Primary Care Provider within 24 hours to let him or her know about the emergency. However, if you have a problem after normal business hours that is not a medical emergency, you can receive services at urgent care centers. Directions on how to find a center are provided in the “Where can I find an urgent care center?” question below.
Certain medical services and supplies require approval before they will be covered by your plan. Preauthorization, also called prior approval or prior authorization, is the process where a qualified health care professional reviews and determines if a service is medically necessary. Your Summary of Benefits indicates which services, supplies or medications require preauthorization. All preauthorization requests are coordinated through your physician’s office, so your provider must ask for and receive approval before you receive care. Priority Partners will review the service, drug or equipment for medical necessity. If preauthorization is not given, then coverage for care, services or supplies may be limited or denied. Any costs for denied services that were the result of an in-network provider failing to receive preauthorization are not your responsibility. For more information on preauthorization guidelines through your Priority Partners plan, refer to your Priority Partners Member Handbook.
A referral is a written order from your primary care provider (PCP) giving you permission to see a specialist or receive certain medical services. Before you can see a specialist and be covered for that care, you will need a referral from your PCP. For information on getting a referral for care, refer to your Priority Partners Member Handbook.
Site of service is a term used to indicate the facility in which you receive care. Many surgical procedures can be performed safely in an outpatient hospital setting, such as an ambulatory surgery center (ASC). Certain procedures require preauthorization when performed in an outpatient hospital setting. For information on covered outpatient services, refer to your Priority Partners Member Handbook.
Some medications require preauthorization from your plan before they can be dispensed by your pharmacy. This helps us ensure that your prescriptions are medically necessary. To determine if a medication requires preauthorization, refer to the Pharmacy Formulary. Medications that require preauthorization are listed in the formulary as “PA”. Your physician can request these medications by submitting a preauthorization request. Information about covered medications, medication preauthorization requirements and pharmacy plan benefits are available here.
Yes, as long as the prescription is on the list of medication covered by Priority Partners. Within two weeks of purchase of the prescription you may be eligible for reimbursement at the retail pharmacy. You may also submit your prescription receipts for reimbursement within 180 days of the date of service. For additional information you can call Priority Partners Customer Service at 800-654-9728.
Contact Priority Partners at 800-654-9728.
Call Priority Partners to change your Primary Care Physician, to add a newborn and mom on the baby’s date of birth, to verify enrollment eligibility, or to obtain an MCO ID card.
You can find an urgent care center near you in three easy steps.
- Go to the provider directory and enter your zip code or select your state from the drop-down menu.
- Click the “Hospital or Facility” option, then click the “Search Providers” button.
- From the search results page, find the “Specialty” search category on the right side, and select “Urgent Care Center” from the drop-down menu.
Eligible Priority Partners members can claim a complimentary gift card for certain preventive care services. Follow these simple steps to verify your mailing information and request a gift card.