Processing claims
How we handle claims, and how your employees can check on their claims.
Checking claim status
- Members can review their claims and benefits through their personal online accounts.
- Customer Service can also help check claim status or answer questions about claims.
Contact Priority Health Customer Service.
Processing different types of claims
Most of our claims are processed electronically, but there is a rare occasion when a member or provider must mail a claim in. It all depends on whether or not the provider, or even the member in some cases, is in our service area.
In-network claims
- Providers in the Priority Health network submit claims for service directly to Priority Health.
- Members should be prepared to pay the provider for any applicable copay at the time of service.
- We'll process the claims according to their plan's benefits and in accordance with our contracted fee schedules.
- Members may receive an explanation of benefits (EOB) with information about how each claim was paid, including a breakdown of copay, deductible, coinsurance and services not covered by their plan.
Non-network claims
- Non-network providers may submit claims for services directly to Priority Health or require members to file claims on their own behalf.
- Members may also be required to pay the provider at the time of service and submit a request for reimbursement to Priority Health.
Print a Member Reimbursement Form (470KB PDF)
PPO networks outside of Michigan
If you have employees who live in another state or outside of the Priority Health service area, we contract with national PPO networks to provide benefits and services for them. National PPO networks usually require providers to send claims directly to them. The network then "reprices" the claim with the negotiated fee and forwards it to Priority Health for processing. The PPO network logo and address are printed on the members' ID cards.
