We’ve made changes to how we process and give updates on provider requests
On March 6, 2020, we made changes our provider operations workflow, which impact how we internally process provider requests, including requests for network participation and change requests.
As a result of the new workflow, new providers who submit a request for participation may not treat Priority Health members until their request is complete and they are set up in our system. Upon completion of their request, providers will receive an email communication that includes a network effective date, which they can begin billing for dates of service on or after. Claims submitted before the effective date may result in incorrect payment or denial.
Participating providers who are requesting to make a change will receive an email communication from us that includes the effective date of change. Providers may begin billing for dates of service on or after that effective date. Claims submitted before the effective date may result in incorrect payment or denial.
As a reminder, you must notify us of changes in your address, staff, tax ID number at least 60 days prior to the change taking effect. We require 90 days advanced notice prior to retirement or termination of contract with Priority Health.
We’ve made improvements to how we’re keeping you informed of the status of your request
We know how important it is for you to stay informed on the status of your requests. We also recognize that every request is unique, and not all workflow steps may be required to complete your request. That’s why we’re launching a new communication process to keep you updated on the status of your unique request, every step of the way.
This new communication process will replace the “Now processing requests” timeline previously located on our website. Rather than providing you with this general processing time frame, we’re now able to send you information specific to your request.
How it works
After a request is submitted, you’ll receive an initial email from us, letting you know we’ve received your request. You’ll also get an inquiry number associated with the request. Keep the inquiry number in a safe place, because it will help us locate your request if you have questions.
Following this initial communication, you’ll receive updates from us at each step in the process, letting you know the status of your request, including any action items or additional information we need from you (if applicable).
Once your request is complete, you’ll receive a final communication from us that includes your effective date. You can begin billing for dates of service on the effective date. Claims submitted before the effective date may result in incorrect payment or denial.
Remember, if submitting a request for new provider participation, you should not treat Priority Health members until you are completely set up in our systems.
For more information
See the Requirements & Responsibilities section in the provider manual.