Medicare AdvantageAdministrativeMedium impact
Reminder: Medicare providers are required to see our dual eligible members regardless of Medicaid status
Priority Health·MI·Government Programs
We identified it
Jun 16, 2026
Summary
Medicare network providers are required to see all dual-eligible members (D-SNP and Dual Premier plans) even if the provider is not in the Medicaid network. This applies when these members have Medicaid as secondary coverage since dual-eligible plans are considered Medicare plans.
Action Required
Immediately: Front desk staff must verify dual-eligible member plan types using prism's Member Inquiry before scheduling. Look for 'PriorityMedicare D-SNP' or 'PriorityMedicare Dual Premier' in Plan Type field. If your practice is Medicare in-network, you must accept these patients regardless of Medicaid network status. Use Find A Doctor tool to verify which dual-eligible plans your practice should be accepting.