Priority Health - Provider Manual

Services list, with which plans require PA, and links to applicable PA forms and medical policies

Auths for BH services

Priority Health's Spine, Weight Loss and Transplant Centers of Excellence

When DME needs authorization

Some drugs require prior auth, including injectables

Requesting high-tech diagnostic studies thru AIM

Browse the policies that guide auths for specific services

What to do when a patient presents with no authorization

Call the Specialty Provider Locator Line to find the care your patient needs

Submitting professional and facility billing; diagnosis coding guidelines

Services paid per capita by age and gender

How Priority Health evaluates code usage

Help for using the most confusing modifiers

Dual coverage, car accidents, Workers' Comp, Medicare eligibles

Protecting the privacy of Priority Health employee patients

Billing for after-hours, BH, DRGs, vaccines, etc.

Revisions to claims, codes, payments

Appealing a denied auth or claim

Everything to know when your first Priority Health patient walks in

Credentialing, contracts, network availability, patient transfers and discharges, extension of care, record-keeping, site visits

Information on Priority Health plans and ID cards

Partners in Performance (PIP); Specialists Pay for Performance (PFP); EMR Incentive program

Medicare-specific instructions for providers, updated 10/07