PriorityMedicare Dual Premier

PriorityMedicare Dual Premier® (HMO D-SNP), our HIDE-SNP plan, will be available to eligible members in some southwest and southeast Michigan counties beginning Jan. 1, 2026.

Dual Premier is a Highly Integrated Dual-Eligible Special Needs Plan (HIDE-SNP), combining Medicare, Medicaid and Long-Term Services & Supports (LTSS) into one plan for an integrated member and provider experience. 

HIDE-SNP vs. D-SNP

HIDE-SNP is replacing D-SNP in certain Michigan regions in 2026 (then all Michigan regions in 2028). D-SNP is coordination-only—so members could have Medicare and Medicaid plans from different payers. Now it will be one plan, with one payer. Providers will have one health plan to interact with for each member, rather than two. This applies to member eligibility, claims, appeals and grievances, inquiries, etc.

Participating with PriorityMedicare Dual Premier

If you’re contracted with either our Medicare or Medicaid product lines, you should see our Dual Premier members. No new contract is needed. However, to be fully reimbursed, you must be enrolled in the Community Health Automated Medicaid Processing System (CHAMPS).

Billing

Providers bill once. The Medicare side of the member’s plan pays out first, then Medicaid picks up the difference, if there is one. If the provider is out-of-network for Medicare or Medicaid, that side of the claim will be paid at the out-of-network level on the fee schedule.

Member cost share

Dual Premier members will have no costs from deductibles, premiums, coinsurance, copayments and cost sharing of any kind, with the exception of PPA or certain medication copays. Providers are forbidden from balance-billing HIDE-SNP members, even if out of network.

Member information

Eligible members should be directed to priorityhealth.com/mapd-plan-info/dual-plan-documents for more information. They can also find a full list of benefits in the Member Handbook.

LTSS

Long-term services and supports (LTSS) encompass the variety of health, health-related, and social services that assist individuals with functional limitations due to physical, cognitive or mental conditions and disabilities. Examples include:

• Adaptive medical equipment & supplies

• Adult day program

• Chore services

• Community transition services

• Environmental modifications

• Private duty nursing

• Respite

LTSS are delivered in both institutional (e.g., nursing homes) settings, community-based settings and member homes.

Under HIDE-SNP, members who meet specific eligibility requirements will receive LTSS that will be provided through Priority Health’s partnership with the Michigan Area Agency on Aging (AAA). The AAAs will manage most administration (i.e. assessments, claims, etc.) using their network, since we don’t offer LTSS.

Members will either be identified by MDHHS as LTSS-eligible or by our Care Management team. Our initial estimate is that 10% of HIDE-SNP members will be eligible for LTSS.

Dual Premier provider manual

A downloadable Priority Health HIDE-SNP provider manual will be available here soon. For now, see our provider FAQs for more questions.

Model of Care training requirement

All dual-eligible special needs plans have a Model of Care (MOC), which ensures the unique needs of each plan member are met. Health care providers play a key role in the Priority Health Model of Care.

The Centers for Medicare and Medicaid Services (CMS) requires all special needs plans (SNPs), like PriorityMedicare Dual Premier, to provide initial and annual MOC training to providers in our Medicare and Medicaid networks. All providers who see PriorityMedicare Dual Premier members must take our Model of Care training. Training must be completed by Dec. 31 of each year.

Priority Health's MOC training is available as an on-demand webinar and takes approximately 15 minutes to complete. Alternatively, some practices and provider groups who are part of an organization may receive Priority Health MOC training along with other annual training requirements. See below for details on each option.

Note: There is one combined training for both of our SNPs, Dual Premier and D-SNP, so completing this training once in 2026 fulfills your CMS requirement.

Option 1: Virtual training

Training is available as an on-demand webinar and only takes 15 minutes to complete. Provider registration for the on-demand webinar counts as attestation, which means no additional documentation is required.

Option 2: Bulk attestation

You can group our MOC training with existing, required training (like compliance training) so you can submit attestation for multiple providers at the same time. If this option is selected, you’ll need to:

1. Distribute training to your providers using this link.
2. To attest to training, you must fill out the roster template with providers who’ve received training. Only the Priority Health MOC roster Excel sheet provided will be accepted.
3. Send attestation rosters to DSNPtraining@priorityhealth.com.

When an attestation is submitted, one of two automated messages will be sent:

• A confirmation email stating the roster was successfully processed.
• An email stating the roster wasn’t processed and the reason(s) why.

Be sure to submit the correct provider NPI.
Ensure the correct provider NPI number is included when submitting the provider roster or registering for the online training. If the NPI is incorrect, the provider’s status will be marked "incomplete" in our system. To correct an "incomplete" status due to an incorrect NPI, resubmit the provider roster or re-register for the online training with the correct provider NPI.

Late submissions will not be accepted.