Reminder: Appointment wait-time standards apply
Did you know that the Centers for Medicare and Medicaid Services (CMS) sets appointment wait-time standards for provider offices and then, they are monitored for adherence to these requirements through secret shopper surveys?
February 2026 medical policy updates
Our Medical Affairs Committee (MAC), comprised of Priority Health network physicians, met in February and approved the following medical policy updates.
2026 HIDE-SNP and D-SNP Model of Care training is now available and required for Medicare and Medicaid providers
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. Our 2026 HIDE-SNP & D-SNP MOC training is now available.
Annual HEDIS audit begins soon
The 2025 MY HEDIS audit begins soon.
Secret shopper survey assessing appointment wait times launches soon
We’re partnering with Press Ganey to launch a secret shopper survey that evaluates in-person and virtual appointment-scheduling wait times for provider offices that accept patients covered under our ACA/marketplace plans.
EVV required for select home health care Medicaid services beginning Jan. 1, 2026
Beginning Jan. 1, 2026 the Michigan Department of Health and Human Services (MDHHS) will require Medicaid claims containing select home health care service (HHCS) codes to be submitted using Electronic Visit Verification (EVV). This requirement applies to all applicable claims submitted with a date of service on or after Sept. 3, 2024.
Final reminder: You must complete our D-SNP Model of Care 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.
November 2025 medical policy updates
Our Medical Affairs Committee (MAC), comprised of Priority Health network physicians, met in November and approved the following medical policy updates.
11/13/2025: Reminder: You must complete our D-SNP Model of Care 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.
10/15/2025 Reminder: You must complete our D-SNP Model of Care 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.
09/03/2025: Annual risk adjustment audits are underway
Risk audits underway
9/2/2025: Reminder: You must complete our D-SNP Model of Care 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.