Frequently asked questions for providers

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.

When a patient presents their Priority Health or Cigna Healthcare ID card, simply follow any instructions for submitting claims, prior authorizations or calling for more information. Contact Priority Health for our members, and Cigna Healthcare for Cigna Healthcare commercial employer-sponsored plans. The alliance excludes Individual Family Plan (IFP) purchased from Cigna Healthcare or healthcare.gov and Medicare plans.

No. Cigna Healthcare commercial employer-sponsored group members and Cigna Healthcare affiliated members continue to have coverage through Cigna Healthcare. The only change is that they have access to providers in Michigan through Priority Health’s PPO network. The alliance excludes Individual Family Plan (IFP) purchased from Cigna Healthcare or healthcare.gov and Medicare plans.

No, this is a Strategic Alliance where Priority Health members will continue to have access to the Cigna Healthcare Open Access Plus® (OAP) provider network when outside of Michigan and Cigna Healthcare employer-sponsored group members will now access the Priority Health PPO network for care inside of Michigan’s lower peninsula. 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.

If the patient has a Cigna Healthcare ID 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. They can obtain in-network care with our Priority Health PPO providers. Priority Health contractual terms and reimbursement apply, with a few exceptions in ancillary care. For Cigna Healthcare members getting ancillary services like durable medical equipment, behavioral health home infusion, and routine vision, Cigna Healthcare's national ancillary agreements will apply. Questions regarding Cigna Healthcare patients should be directed to Cigna Healthcare at the number on the back of their ID card.

You’ll be out-of-network for Cigna Healthcare members in Michigan.

No. If you’re a credentialed provider with Priority Health, you’re all set to serve Cigna Healthcare commercial medical patients in Michigan. Priority Health sends our participating provider information to Cigna Healthcare bi-weekly. Cigna Healthcare will not add or change providers unless it comes from Priority Health. They use our provider data for considering if a provider is in-network for their Michigan members. This also streamlines the process for our providers. You’ll only need to send changes to us.

Need to make changes? Update your information through prism.

Participating providers will display in Cigna Healthcare’s Provider Directory.

If you’re already credentialed with Priority Health, there's nothing you need to do. You do not need to be credentialed with Cigna Healthcare to see their Michigan commercial medical 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 with Cigna Healthcare to see Cigna Healthcare members in Michigan.

You shouldn't see Priority Health or Cigna Healthcare members who are seeking in-network care from Priority Health providers until you receive notice from us that your request for network participation is complete, along with a network effective date. When we receive your complete credentialing information, it can take us up to 80 calendar days to process your request. Visit here for more information about credentialing.  

If you're contracted with Priority Health in Michigan's lower peninsula, you'll be able to continue seeing Cigna Healthcare commercial members. You'll be reimbursed for Cigna Healthcare members at the same rates you receive for your Priority Health members except for certain ancillary services. Cigna Healthcare national ancillary agreements in place will supersede for Cigna Healthcare customers.

For Cigna Healthcare employer-sponsored group members, they'll have access to Priority Health's PPO network. If a provider is not in the Priority Health network, they'll be considered out of network for Cigna Healthcare commercial members.

The member is now in-network and the provider will be paid according to their Priority Health agreement.

When a patient presents their Cigna Healthcare member ID card, simply follow any instructions on the member ID card for eligibility, submitting claims, prior authorizations or calling for more information. Visit CignaforHCP.com Patients. To use this tool, you must be a registered user with access to view patient information.

Cigna Healthcare Customer Service: 800.88Cigna (800.882.4462).

Cigna Healthcare employer-sponsored groups with access to the Cigna Healthcare Open Access Plus® (OAP) network and a Cigna Healthcare ID card access Cigna Healthcare’s nationwide network. When they live in or travel to Michigan, they can access in-network care through Priority Health’s PPO network. The alliance excludes Individual Family Plan (IFP) purchased from Cigna Healthcare or healthcare.gov and Medicare plans.

Our Strategic Alliance with Cigna Healthcare uses our PPO network and applies to Cigna Healthcare’s commercial group members. If you see other Cigna Healthcare patients, such as a Cigna Healthcare Medicare, Medicaid or Individual patient, and don’t have a Cigna Healthcare contract for that product, the patient’s out-of-network benefits will apply. Individual Family Plan (IFP) purchased from Cigna Healthcare or healthcare.gov and Medicare plans are excluded.

Your Cigna Healthcare 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 Healthcare members living in Michigan. Most Cigna Healthcare members in Michigan—about 80%—are on the east side of the state.

Yes. These Strategic Partners include:

• HealthPartners (Minnesota, North Dakota, Western Wisconsin)
• MVP (upstate and western New York area, Bradford County, PA)

Any health plans with access to Cigna Healthcare's national network can use the Priority Health PPO network. There is no difference between treating patients with Strategic Alliance plans and those with coverage through Cigna Healthcare plans. EOBs and claim payments come directly from the alliance health plan. 

For more information about these Strategic Partners, including sample member cards, see Cigna Healthcare’s online guide.

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 Healthcare members, log in to Cigna Healthcare for Health Care Professionals > Patients > View and submit precertification. To use this tool, you must be a registered user with precertification access.

Visit Cigna Healthcare for Health Care Professionals > Patients > View and submit precertification. To use this tool, you must be a registered user with precertification access. Or call Cigna Healthcare Customer Service and 800.882.4462.

Cigna Healthcare commercial employer-sponsored  Open Access Plus® (OAP) members in Michigan will use Priority Health’s PPO network for ancillary care. eviCore healthcare® (eviCore) manages home health care, durable medical equipment (DME) and home infusion therapy for Cigna Healthcare commercial customers. eviCore has a national network of providers who offer these services. Providers with national ancillary agreement with Cigna Healthcare, that agreement supersedes their Priority Health contract.

Exception 1: Behavioral health, transplants and optometry

For these services, Cigna Healthcare members need to see a Cigna Healthcare or Evernorth Behavioral Health provider. Providers and members can search for providers on the Cigna Healthcare Find a Doctor tool. ID cards may also display what company to call for certain services.

Providers must request a prior authorization if needed. For authorizations, providers can visit Cigna Healthcare 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 Healthcare.

To find behavioral health authorization requirements and billing practices for Cigna Healthcare members, visit Evernorth Provider Resources.

Transplants must be provided through Cigna Healthcare LifeSource Transplant Network. Visit here for more information.

Vision: Routine eye exam, eyeglasses or contacts services must be provided by an EyeMed provider. Providers can validate participation here:  Vision Provider Locator

Eye injury or eye disease: Ophthalmologists and optometrists that appear in Cigna Healthcare Directory are part of Cigna Healthcare's medical network. Routine care from those providers may not be covered by the member’s plan.

Exception 2: Home health, infusion, labs and dialysis

Either Cigna Healthcare or Priority Health’s network can be used for these services. Providers can be found on either Cigna Healthcare’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 Healthcare’s network will supersede for Cigna Healthcare members. Example: national lab LabCorp has a contract with Cigna Healthcare and Priority Health, so therefore Cigna Healthcare would reimburse the claim. 

Cigna Healthcare 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.

Visit eviCore or call eviCore at 888.693.3297.

For Priority Health members, continue to use the Auth Request tool to request high-tech radiology authorizations through eviCore.

Review the Cigna Healthcare ID card and contact the phone number noted on the card for specific benefit information.

There’s no change for your existing Priority Health patients. For Cigna Healthcare members, Priority Health contractual terms and reimbursement apply, with a few exceptions in ancillary care. For Cigna Healthcare members getting ancillary services like durable medical equipment, behavioral health home infusion, and vision Cigna Healthcare's national agreements and reimbursement will apply.

To see our fee schedules, log in to your account.

Cigna Healthcare will verify claims matches the provider information received by Priority Health. Claims need to match billing name, address, tax id, and NPI. If the information does not match, the claim will price out-of-network.

If an ancillary service is not provided by the required provider based on the member’s plan, it could price out-of-network.

Yes, Priority Health commercial group members that get care outside of Michigan have access to the Cigna Healthcare Open Access Plus (OAP) network. OAP in-network providers can be found on Cigna Healthcare’s provider directory.

No, only commercial group members.

Claims for Priority Health members should always be submitted to Priority Health, not Cigna Healthcare. Simply follow any instructions on the member ID card for submitting claims, prior authorizations or calling for assistance. More information on billing and authorizations for providers outside of Michigan can be found on our site.