Reminder: Do NOT collect upfront deductible or coinsurance payments from PriorityHRA members
Priority Health plans may include a health reimbursement arrangement (HRA). These commercial plan add-ons can be identified via the member ID card and in prism. Providers should not collect estimated deductible or coinsurance payments from Priority Health members with an HRA in advance of billing Priority Health. Instead, collect any required copays at the time of service and submit claims for other costs of care to Priority Health first. Priority Health will pay providers directly from the member's HRA for eligible expenses.
Providers may be asked to complete attestation form for eligible Medicare members to qualify for SSBCI
Beginning Jan. 1, 2027, Medicare members on PriorityMedicare Align, Latitude, D-SNP and Dual Premier may be eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI). Some members who already receive SSBCI will have their eligibility renewed. For others, a provider must attest on the member’s behalf that they have all of the following: • One or more qualifying conditions • A high risk of hospitalization or other adverse health outcomes • A need for intensive care coordination • Clinical rationale for receiving SSBCI
Beginning October 1, some noncitizens will lose Medicaid coverage
Starting Oct. 1, 2026, federal rules will change Medicaid eligibility for certain noncitizens. Members impacted by this change will transition to Emergency Services Only (ESO) coverage through the state of Michigan and will no longer have Priority Health Medicaid coverage, effective immediately. Impacted members have been notified by both MDHHS and Priority Health.
HIDE-SNP members may qualify for LTSS
HIDE-SNP members may qualify for long term support services
6/22/2026: Reminder: Changing ACNs may change your patients’ access to you or their cost share
Providers, remember that if you change your ACN affiliation, it may have the unintended consequence of changing your network status for some plans, pushing you out of network or into a higher tier for patients you’re currently seeing, particularly if the member is on a narrow or tiered network plan.
6/22/2026: Members with a PHP TPA card have access to Priority Health’s network through the Cigna Strategic Alliance
Be on the lookout for a card with Priority Health and Cigna logos that says “Plan administered by PHP TPA services.” This is a PHP TPA card. Members with this plan have access to Priority Health’s PPO network and should be seen the way Cigna and Cigna-affiliated members in Michigan are seen through our Strategic Alliance with Cigna. Follow the directions on the back of the PHP TPA member ID card for requesting authorization (precertification) and submitting claims.
6/22/2026: New optional supplemental product offers member incentives for choosing top-performing providers
To meet member and employer demand for greater visibility into provider quality and more affordable healthcare, we’re offering a new optional supplemental product for commercial group employers in partnership with Garner Health that will identity top-performing providers in our network and cover out-of-pocket costs for participating members who choose to see these providers. The Garner product will be available to most employer groups and their members beginning August 1.
6/8/2026: Reminder: Medicare providers are required to see our dual eligible members regardless of Medicaid status
Are you in our Medicare network? If so, you’re required to see our dual-eligible members (D-SNP and Dual Premier) even if you’re not in our Medicaid network. This is true even if the member has Medicaid as their secondary coverage.
2/24/2026: Cigna covered plans clarification
Through our Strategic Alliance with Cigna Healthcare, members with any employer health plan through Cigna and their affiliates are in network with Priority Health PPO providers. These members should be considered in network even if “Open Access Plus” or “OAP” does not appear on their member ID cards.
1/20/2026: PriorityMedicare Dual Premier, our HIDE-SNP plan, went live on January 1
Beginning January 1, 2026, PriorityMedicare Dual Premier® (HMO D-SNP) replaced PriorityMedicare D-SNP in some southwest and southeast Michigan counties. Dual Premier, which is a Highly Integrated Dual-Eligible Special Needs Plan (HIDE-SNP), combines Medicare, Medicaid and Long-Term Services & Supports (LTSS) into one plan for an integrated member and provider experience.
12/22/25: Reminder: $0 skin checks for Medicare wellness plan members are for annual screenings only
Priority Health members with a wellness plan (Thrive and Thrive Plus) have a number of extra preventive benefits, including a $0 annual skin check. Please remember that this benefit only covers a skin cancer screening by a dermatologist . If anything besides this screening is done at the visit, the member may incur a cost.
10/27/25: New Priority Health products coming January 1, 2026
Check out our annual product updates guide to see product changes taking effect January 1, 2026.