Getting Started

Find everything you need to know when your first Priority Health patient walks in the door in our online Provider Manual. Here are some quick links to top pages, but you can also go to the Provider Manual home page to see a full table of contents.

Jump down the page to:

• Getting set up with online services
• Patient eligibility
• Collecting from the patient
• Authorizations
• Submitting a claim
• Tips for success
• Call us with questions

Getting set up with online services

• How do I get set up for electronic billing, electronic funds transfer, electronic RAs, etc.?
• How do I get access to online tools?

Patient eligibility

Always ask patients for their Priority Health ID card.

• What do Priority Health ID cards look like?
• What different plans does Priority Health offer?

Collecting from the patient

Copays are listed on the patient's ID card. You'll usually get answers to the questions below by logging in to your online provider account and then using our Member Inquiry tool. 

• Should I collect something beyond a copay from the patient? Should I collect for the full amount? Call us for answers.
• Does the patient have a deductible?  Call us for answers.

Authorizations

If you need an authorization immediately, call your Provider Help Line (listed below). Otherwise, use the forms and processes here.

• When does Priority Health require prior authorization?
• Where are the prior auth forms?

Submitting a claim

• Where do I send my claim?
• How do I bill a HCFA 1500?
• How do I bill a UB04?

See billing instructions for specific procedures and services.

Tips for success

• Register your account online as soon as possible, and call your provider representative to come show you around our website and its tools: Member Inquiry, Patient Profile, Authorizations, and Claims.
• When you don't know where a form or "how-to" is online, use the Search box in the upper right corner of your screen. Our Google-powered search will help you find what you need, fast.
• Check eligibility prior to the member's arrival at your office if possible. (The Member Inquiry tool makes this fast and easy.)
• Collect the patient's copay at the time of service. (It's listed on his or her Priority Health ID card, and in Member Inquiry.)
• For HSA members: wait until you get the RA from us to know the exact deductible balance, because pending claims prior to yours may change the balance shown online.

Call us with questions

Provider Help Line

• 616 942-4765 (Grand Rapids)
• 800 942-4765
• Hours: Monday - Friday: 7:30 a.m. - 5:00 p.m.  
• E-mail: provider.services@priorityhealth.com

Pharmacy Help Desk for Providers

• 616 464-8163 (Grand Rapids)
• 800 466-6642
• Monday - Thursday 9:00 a.m. - 7:00 p.m.; Friday 9:00 a.m. - 6:00 p.m.; Saturday 8:30 a.m. - Noon