Responsibilities and standards news
November 2024 medical policy updates
Our Medical Advisory Committee (MAC), comprised of Priority Health network physicians, met in November and approved a series of medical policy updates.
June 30, 2025
August 2024 medical policy updates
Our Medical Advisory Committee (MAC), comprised of Priority Health network physicians, met in August and approved the following medical policy updates.
June 30, 2025
Complete our DSNP Model of Care Training
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) 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 PriorityMedicare patients are trained on our Model of Care.
June 30, 2025
Reminder to complete our CMS-required D-SNP Model of Care training
All providers who are part of the Priority Health Medicare Advantage network need to complete training. This includes specialists, ancillary providers, or anyone part of an ICT (interdisciplinary care team) for a D-SNP member. This is a CMS requirement.
June 30, 2025
Unique NPI required for rehab groups to credential BH providers
We’re reminding all rehabilitation groups credentialed with us that, if they’d like to also provide behavioral health (BH) services, they’ll need to obtain a unique NPI specific to their BH services.
June 30, 2025
Mandatory pSA renewal reminder | Provider | Priority Health
Our annual prism Security Administrator (pSA) renewal period is underway. By August 1, pSAs need to review and either approve or deny all user affiliations for your group or facility so that they don’t lose access to essential data.
June 30, 2025
Reminder you must refer members to in-network providers including labs
Participating providers have a contractual obligation to use in-network providers when referring our members for services, regardless of your own contracts for referrals with non-participating labs.
June 30, 2025
Reminder of our technical denials policy
We'll begin applying technical denials to in-network providers' claims on Dec. 29, 2024.
June 30, 2025
PriorityMedicare D-SNP Model of Care training
PriorityMedicare D-SNP Model of Care training for providers
June 30, 2025
pSA mandate, phase 1
Starting September 23, prism users will only be able to affiliate to groups or facilities that have a pSA. If the group doesn’t have a pSA, users will not be able to access the group’s data until the group assigns a pSA. This means users won’t be able to use prism to submit authorizations, see claims or appeals, etc.
June 27, 2025
2024 Child CAHPS and CSHCS CAHPS results available
The 2024 Child CAHPS and CSHCS CAHPS survey results are now available for providers.
June 27, 2025
Reminder: You must complete our MOC training by Dec. 31
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) 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 PriorityMedicare patients are trained on our Model of Care (MOC) every year.
June 27, 2025