After hours only:

Call 800.269.1260 for urgent authorizations

Leave a phone number and message. A nurse case manager will return your call within 30 minutes.

 
 

Provider contacts

Call the Provider Helpline

800.942.4765

Mon.-Thurs. 7:30-5; Fri. 9-5

Press:
1 – Dental providers
2 – Claims, benefits, Medicare, member eligibility
3 – Pharmacy
4 – Authorization or health management status
5 – Behavioral Health
6 – Website and password help
7 – Connect to 5-digit staff extension 

More contact information:

Appeals

In-network providers: Log in and use the Mailbox to send information securely.

Out-of-network providers: Fax 616.975.8856

For instructions and forms, check the Provider Manual:

Authorizations,
authorization status

800.942.4765,
option 4

Mon.-Thurs. 7:30-5;
Fri. 9-5

Urgent after-hours authorizations only:
Call 800.269.1260. Leave a phone number and message. A nurse care manager will return your call within 30 minutes.

Online tool for logged in providers: Auth Inquiry

Fax 616.942.0024

Priority Health Authorizations
MS 1255
1231 East Beltline NE
Grand Rapids, MI 49525

Prior Auth Reference List

Behavioral health

800.673.8043

Mon.-Fri. 8-5

Emergency treatment for behavioral health conditions does not require prior authorization.

Non-emergency inpatient authorization requests, fax to: 616.975.0249
A clinician will contact you during regular business hours.

Find behavioral health prior authorization forms

Care managers

Mon.-Fri. 8:30-5

List of Priority Health care manager assignments by PCP (299 pages)

Once you find the care manager assigned to you, call 800.998.1037, then the extension listed next to the care manager's name.

Claims

Online tool for logged-in providers: Claims Inquiry

Submitting claims

In our Provider Manual > Billing and payment section, go to:

Status a claim

Request reconsideration

Request a claim review - learn the process

No DCN number?

For general billing questions, email provider.services@priorityhealth.com

Contracting,
locum tenens

800.942.4765

Mon.-Fri. 8:30-5

Fax 616.975.8851 (West/Northern Michigan)
Fax 248.324.2984 (East Michigan)

Priority Health Contracting
MS 2320
1231 East Beltline NE
Grand Rapids, MI 49525

Join the Priority Health network

Credentialing,
enrollment

800.942.4765

Mon.-Fri. 8:30-5

Email: PH-PELC@priorityhealth.com
Fax 616.975.8857
Priority Health Provider Enrollment & Life Cycle
MS 2320
1231 East Beltline NE
Grand Rapids, MI 49525

Credentialing

Drug authorizations,
formulary exceptions

800.466.6642

Mon.-Thurs. 7:30-7;
Fri. 8-7;
Sat. 8:30-Noon

Pharmacy Help Desk

Fax 616.942.8206

Approved Drug List

Drug prior auth forms

Electronic data,
file exchange info & setup

5010 format for data exchange

EDI (electronic data interchange for billing, claims)

EFT (electronic funds transfer)

HL7 (Health Level 7 supplemental patient data exchange)

Patient discharge requests

Form and instructions

Fax 616.975.8887

Performance Programs 

Partners in Performance program: Clinical outcomes, patient experience, access, efficiency and care transformation

Find your Provider Performance Specialist for help participating in our incentive program

Last modified: 4/24/2017
Life just got a little easier

You need to install a Flash plugin to see this video.