Changes to Staff/Address/Phone

Reporting most changes
To notify Priority Health of changes in your address, staff, tax ID number, or if you are accepting or closing to new patients, follow these steps:

Step 1: 60 days or more before the change takes effect, complete and print the form:

1. • Provider Demographic Change Form (515KB PDF)
     
   • Behavioral Health Provider Change Form (117KB DOC)
     

Step 2: Fax or mail the form to Priority Health at the address/fax number on the form.

Reporting Retirement/Termination
At least 90 days prior to your retirement or termination of contract with Priority Health, send us a letter signed by the contract holder notifying us of the change.

Where to send changes
Address all correspondence to Provider Services addresses.