Provider Manual
I want to...
- Appeal a denied claim
- Approved Drug List
- Authorizations
- Check claim status
- Check patient eligibility
- compliance policy
- Correct a claim
- Request a drug authorization
- File a claim
- Participate with Priority Health
- See medical policies
- Find provider forms
- Cigna Strategic Alliance
- Clinical resources
- Information on COVID-19 for Providers
- Medication Therapy Management (MTM) Program
- Opioid management guidelines and resources
- Specialty pharmacy process
- Formulary updates
- Request an exception to the formulary
- Contact Priority Health provider services
- Set up electronic funds transfers
- Set up electronic claims / RAs
-
Check patient eligibility
-
Plans & benefits
-
Authorizations
-
Find medical policies
-
Procedures & services
-
Drugs
-
Billing & payment
-
Check claim status
-
Set up electronic claims/RAs
-
Set up electronic funds transfers
-
Reviews & appeals
-
Requirements & responsibilities
-
See the compliance policy
-
Find provider forms
-
Clinical resources
-
News & education
-
Join our networks
-
Request an account
-
Seeing Cigna members in MI
Recent news
(April 5) Don't forget to register for PRA training
(March 30) Celebrating National Doctors' Day
(March 23) COVID-19 treatment coverage with $0 cost-share extended to Sept. 30
(March 17) Serving Cigna members in Michigan
(March 16) New provider portal coming this year
(March 05) Learn how to use our new tool to manage provider information for PIP settlement
(March 02) Musculoskeletal prior auths moving from eviCore to GuidingCare starting April 5
(March 02) We’re moving to eviCore criteria forcertain multi-gene panels
(February 19) Facilities: Starting March 1, you'll see newborns on mothers' remits
(February 15) Telehealth billing process and policy updates coming March 1
(February 11) Use our online portal to submit your post-claims appeals and medical records
(February 11) eviCore is now processing retrospective radiology and musculoskeletal authorizations up to 360 days
(February 10) Register for the behavioral health collaborative care (BHCC) meetings to remain eligible for the BHCC incentive measure
(February 5) We’re making it easier for you to manage your provider data for PIP
(February 2) 2021 PriorityMedicare D-SNP Model of Care provider training is now available
(January 29) We’re transitioning our retrospective genetic lab authorizations to eviCore for in network providers and labs
(January 25) Preferred biosimilars for pegfilgrastim effective April 1
(January 25) Supporting mental wellness with myStrength
(January 19) Expanding outreach for osteoporosis gaps in care
(January 19) 2021 PCP Incentive Program (PIP) webpage updates
(January 6) New scam alert: fraudulent prescription and certificates of medical necessity (CMN) requests
(January 6) COVID-19 vaccine billing and reimbursement
(December 30) Class I Drug Recall: Anagrelide Capsules, USP 1 mg
(December 30) The Center for Medicare Services (CMS) is updating the Medicare outpatient therapy threshold
(December 24) 2021 CPC+ and PCP Incentive Program manual available
(December 15) Update on our Strategic Alliance with Cigna, effective Jan. 1
(December 11) We’ve made our guidelines for billing Medicare outpatient therapy service easier for you
(December 11) We‘ve updated the Provider Information Form
(December 11) Drug recall: Paroex® Oral Rinse
(December 11) New 2021 changes to E/M codes
(December 8) Reminder: D-SNP Model of Care training due Dec. 31, 2020
(December 2) Extensions for $0 cost share for telehealth, COVID-19 treatment and a commitment to $0 vaccine coverage
(November 24) Ongoing support for you and your patients in the fight against COVID-19
(November 20) Medicare and Medicaid member engagement and support programs
(November 16) Update to salpingectomy coverage
(November 13) Inovalan to begin chart reviews for commercial members
(November 6) Updated PIP and CPC+ manuals
(November 5) Reminder: D-SNP Model of Care training due Dec. 31, 2020
(November 3) Jan. 1, 2021 commercial and Medicare product information
(November 3) Turnaround times for processing your credentialing and enrollment requests now available