Provider Manual
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- Appeal a denied claim
- Approved Drug List
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- compliance policy
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- See medical policies
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- Cigna Strategic Alliance
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- Information on COVID-19 for Providers
- Medication Therapy Management (MTM) Program
- Opioid management guidelines and resources
- Specialty pharmacy process
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- Request an exception to the formulary
- Contact Priority Health provider services
- Set up electronic funds transfers
- Set up electronic claims / RAs
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Check patient eligibility
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Plans & benefits
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Authorizations
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Find medical policies
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Procedures & services
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Drugs
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Billing & payment
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Check claim status
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Set up electronic claims/RAs
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Set up electronic funds transfers
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Reviews & appeals
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Requirements & responsibilities
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See the compliance policy
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Find provider forms
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Clinical resources
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News & education
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Seeing Cigna members in MI
Recent news
(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
(October 29) 2021 commercial fee schedules now available
(October 27) Jan.1, 2021 commercial and Medicare formulary changes
(October 20) Drug recall: Nature Throid® and WP Thyroid®
(October 15) Reminder: Submit post-claim appeals and medical records through the Claims tool
(October 6) Reminder: D-SNP Model of Care training due Dec. 31, 2020
(October 2) ePA for pharmacy now available through the Surescripts portal
(October 1) 2021 PIP preliminary manual
(September 29) Claims processing for providers at temporary locations for COVID-19 ends Sept. 30
(September 22) GuidingCare tips: InterQual® and expedited authorization requests
(September 21) Do you provide acupuncture services? Let us know.
(September 16) GuidingCare reminder: no longer accepting in-network authorization faxes and tips for quicker authorization processing
September 13) Alert message displaying in error for PriorityMedicare Edge PPO members in GuidingCare
(September 8) 2020 AHA claims submission deadline is Feb. 28, 2021
(September 4) New authorization tool launches September 14
(September 3) Reminder: Cost Estimator available to all providers
(September 3) MDHHS announces $25M PPE grant
(September 2) Mandatory blood lead testing for children covered under Medicaid and WIC