New Child CAHPS and CSHCS CAHPS results available
Each year, the Michigan Department of Health and Human Services (MDHHS) contacts select Medicaid members to better understand the quality of care they receive from their providers and health plan. Recent CAHPS results show strong performance in provider communication, with opportunities to further improve members’ overall care and specialist experiences.
Reminder: Leave appointments open to remain compliant to availability standards
The Centers for Medicare and Medicaid Services (CMS) sets appointment wait-time standards for provider offices, and CMS monitors providers for adherence to these requirements through secret shopper surveys. It’s crucial for provider offices to structure their schedules to allow for new appointments to be scheduled in a timely manner.
Reminder: You must complete our CMS-required HIDE-SNP and D-SNP Model of Care training by Dec. 31
Providers play an integral role in the care teams that support our special needs plans (SNPs) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see Medicare or Medicaid members are trained on our Model of Care (MOC) every year.
Modifier 55 billing update for ophthalmology claims, effective Jan. 1
For claims with dates of service on or after Jan. 1, 2027, ophthalmologists billing post-operative care using Modifier 55 must follow updated claim submission requirements.
Reminder: You must complete our CMS-required HIDE-SNP and D-SNP Model of Care training by Dec. 31
Providers play an integral role in the care teams that support our special needs plans (SNPs) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see Medicare or Medicaid members are trained on our Model of Care (MOC) every year.
Providers may receive requests for HIDE-SNP member medical records
As part of the Priority Health Medical Record Review (MRR) process, we’re sending out requests to some providers in our Medicare and Medicaid network for PriorityMedicare Dual Premier members. Follow the instructions in the letter to return all requested medical records within 30 days.
New Medicaid-only credentialing form now available
Starting Oct. 1, 2026, new individual providers enrolling with Priority Health for Medicaid only will use a new standardized credentialing and enrollment form. This change is in alignment with the Michigan Department of Health and Human Services (MDHHS) new requirements for Michigan’s Medicaid Health Plans[JW2.1] (MHPs).
ETS exclusivity expanding to Medicare and Medicaid
Effective Oct. 1, 2026, Emerging Therapy Solutions (ETS) will be Priority Health’s exclusive vendor for bone marrow transplants, organ transplants and CAR T-cell and gene therapies. This will be in effect across all lines of business, now including Medicare and Medicaid. ETS will reach out to all Michigan hospitals they’re currently contracted with about expanding the agreement to include Medicare and Medicaid.
Reminder: Access to care standards apply
We’re committed to helping members access care when they need it – 24 hours a day, seven days a week. We expect providers to follow the appointment and timely access to care standards outlined in the Priority Health Plan provider contracts .
Reminder: You must complete our CMS-required HIDE-SNP and D-SNP Model of Care training by Dec. 31
Providers play an integral role in the care teams that support our special needs plans (SNPs) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see Medicare or Medicaid members are trained on our Model of Care (MOC) every year.
August 2026 medical policy updates
Our Medical Affairs Committee (MAC), comprised of Priority Health network physicians, met in August and approved the following medical policy updates.
Reminder: You must complete our CMS-required HIDE-SNP and D-SNP Model of Care training by Dec. 31
Providers play an integral role in the care teams that support our special needs plans (SNPs) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see Medicare or Medicaid members are trained on our Model of Care (MOC) every year.