Priority Health + Cigna Strategic Alliance
What providers need to know about our new Strategic AllianceSince 2018, Priority Health and Cigna have partnered to offer Priority Health commercial group members living or traveling outside Michigan access to Cigna's nationwide network of providers. Starting January 1, 2021, Priority Health and Cigna have entered a Strategic Alliance. This means:
- Cigna commercial group members that get care in Michigan can access the Priority Health preferred provider organization (PPO) network
- Priority Health commercial group members that get care outside of Michigan have access to the Cigna network
Seeing a Priority Health or Cigna member in Michigan
|Question||Priority Health member||Cigna member|
|How do I know if my patient has Priority Health or Cigna as the primary plan administrator?||Your patient will have a Priority Health ID card.||Your patient will have a Cigna ID card.|
|What is the network and governing contract for reimbursement?||
|How do I confirm eligibility or benefits for my patients?|
|How do I submit claims?||
|Who processes claims and issues the explanation of payment, explanation of benefits, or statement of account?||Priority Health||Cigna|
|How can I review claim status?||
See the back of the patient's ID card.
Cigna Customer Service: 800.882.4462
|How do I submit an appeal?||See the Provider Manual for information on claims and authorization appeals by plan type.||
Attn: Cigna Appeals Unit
If the Cigna ID card indicates GWH-Cigna or 'G' on the front of the card:
Attn: Cigna Appeals Unit
|Who do I contact for prior authorization or for medical management services?||
|How do I request prior authorizations for high-tech radiology?||
In Michigan: Login to your provider account and Request an Authorization
Outside Michigan: Use our provider manual
All commercial members* will receive new ID cards by Jan. 1, 2021. All members receiving an ID card will receive an insert with their new card outlining why they're receiving the card and when to use it. Samples are shown below. Note that actual ID cards may vary depending on plan type, funding type and other factors.
*Includes commercial group and individual members, excludes employer or Individual MAPD plans.
Priority Health members living in Michigan
Priority Health members living outside of Michigan
Cigna members living in Michigan will have the Priority Health logo on their Cigna ID card
About the Strategic Alliance
For our provider partners, our collaboration will use the best capabilities of both organizations to give you a more predictable and simplified experience. We're working to collaborate and align processes to add value in areas that include clinical criteria, clinical edits, authorizations, appeals and more.
This will also give employers in Michigan more choices and access to affordable care for their employees.
Your practices don't need to do anything differently. When a patient presents their Priority Health or Cigna member ID card, simply follow any instructions for submitting claims, prior authorizations or calling for more information. Contact Priority Health for our members, and Cigna for Cigna members.
No. Cigna members continue to have coverage through Cigna. The only change is that they have access to providers in Michigan through Priority Health’s PPO network.
No, this is a Strategic Alliance where Priority Health members will continue to have access to the Cigna provider network when outside of Michigan and Cigna members will now access the Priority Health PPO network for care inside of Michigan. This relationship delivers a competitive network solution for Michigan employers based on shared capabilities and the strength of our provider relationships, but both companies will continue to operate independently.
Contracting and credentialing
If the patient has a Cigna card with the Priority Health logo or is a traveling member with an Away From Home Care logo, you should see them and bill following instructions on their ID card. You’ll be reimbursed at your normal Priority Health rates for the care you provide. Questions regarding Cigna patients should be directed to Cigna at the number on the back of their ID card.
You’ll be out-of-network for Cigna members in Michigan.
No. If you’re a credentialed provider with Priority Health, you’re all set to serve Cigna patients in Michigan.
If you’re already credentialed with Priority Health, there's nothing you need to do. You do not need to be credentialed with Cigna to see their Michigan members.
If you’re in Michigan and have a new provider joining your office, continue to credential with Priority Health following the same process you always have. You do not need to credential them with Cigna to see Cigna members in Michigan.
If you're contracted with Priority Health in Michigan's lower peninsula, you'll be able to continue seeing Cigna commercial members. You'll be reimbursed for Cigna members at the same rates you receive for your Priority Health members.
For Cigna members, they'll have access to Priority Health's PPO network as of January 1, 2021. If a provider is not in the Priority Health network by that time, they'll be considered out of network for Cigna commercial members.
The member is now in-network and the provider will be paid according to their Priority Health agreement.
Seeing Priority Health and Cigna members in Michigan
When a patient presents their Priority Health or Cigna member ID card, simply follow any instructions on the member ID card for submitting claims, prior authorizations or calling for more information.
Priority Health commercial members with a Priority Health card continue to have access to the entire Priority Health network and access to coverage outside of Michigan through Cigna. Individuals with Cigna coverage and a Cigna ID card access Cigna’s nationwide network. When they live in or travel to Michigan, they can access in-network care through Priority Health’s PPO network.
Our Strategic Alliance with Cigna uses our PPO network and applies to Cigna’s commercial group members. If you see other Cigna patients, such as a Cigna Medicare, Medicaid or Individual patient, and don’t have a Cigna contract for that product, the patient’s out-of-network benefits will apply.
Your Cigna patients can continue to see their providers if the provider is in the Priority Health PPO network. There will be no change for the patient.
There are approximately 120,000 Cigna members in Michigan. Most Cigna members in Michigan—about 80%--are on the east side of the state.
There's no change to how you request or status an authorization. See the patient's ID card for instructions. For Priority Health members, continue to use the Auth Request tool.
For Cigna members, log in to Cigna for Health Care Professionals > Patients > View and submit precertification. To use this tool, you must be a registered user with precertification access.
Cigna members in Michigan will use Priority Health’s PPO network for ancillary care, with the following exceptions:
Exception 1: Behavioral health, transplants, optometry and telehealth (medical & BH)
For these services, Cigna members need to see a Cigna provider. Cigna has created a co-branded Provider Directory specifically for Priority Health, available to Cigna members on priorityhealth.com. Providers must request a prior authorization if needed. For authorizations, providers can visit Cigna for Health Care Professionals > patients > view and submit pre-certification, or call customer service at 800.882.4462. Providers need to submit these claims to Cigna.
To find behavioral health authorization requirements and billing practices for Cigna members, visit Cigna for Health Care Professionals > Resources > Behavioral Resources > Doing Business with Cigna > Authorization and Billing Resource.
Exception 2: Home health, infusion, labs and dialysis
Either Cigna or Priority Health’s network can be used for these services. Providers can be found on either Cigna’s Provider Directory or Priority Health’s Find a Doctor tool. If required, prior authorizations may be requested through the appropriate network. If there is a duplicate national contract for these services, then Cigna’s network will supersede. Example: national lab LabCorp has a contract with Cigna and Priority Health, so therefore Cigna would reimburse the claim. Cigna members can choose whichever lab they want to, but the provider payment would be dictated by who has the national contract.
Cigna for Health Care Professionals: To use this tool, you must be a registered user with precertification access. Once logged in, you will be able to look up precertification requirements under Useful Links > Precertification Policies.
CHCP - Resources - Precertification: Click on the Complete List of Services to see which require precertification. This webpage also has a link to frequently asked questions related to precertification.
There’s no change for your existing Priority Health patients. If you previously served Cigna patients through their previous Strategic Alliance with Health Alliance Plan (HAP) or one of Cigna’s third-party vendor contracts in Michigan, you may receive a different reimbursement amount for these patients than you did from HAP or other vendor. It will be the same reimbursement you receive for the care you provide Priority Health members.
If you are a Cigna provider seeing a Priority Health member outside of Michigan, visit our out-of-state provider page.
Questions about Priority Health members?
Call the Priority Health Provider Helpline at 800.942.4765 Mon.-Thurs. 7:30-5; Fri. 9-5.
Questions about Cigna members?
Call Cigna at 800.882.4462.