New Provider Education Module: Updating your Find a Doc information in prism
How to update FAD provider information in prism
August 2025 medical policy updates
Our Medical Affairs Committee (MAC), comprised of Priority Health network physicians, met in August and approved the following medical policy updates. Unless otherwise noted, the changes will go into effect on Sept. 1, 2025.
Change to ACN enrollment rules
Effective July 8, 2024, we’ll no longer allow providers to be enrolled under more than one ACN contract at a time under the same NPI, TIN and address. This includes ACNs with both direct and delegated contracts.
Annova: New vendor supporting medical record retrieval
New vendor supporting medical record retrieval for risk adjustment.
07/15/2025: prism login reminder
Make sure you’re logging into prism frequently. After 120 days without a login, your account will be considered inactive, and you’ll temporarily lose access.
Medicaid audit underway
The state is sending providers requests for Priority Health Medicaid patients' medical records.
Technical denials no longer apply to in-network providers' claims
We’re no longer applying technical denials to in-network provider claims.
IMRT to be added to post-pay audit program effective Aug. 23
Effective Aug. 23, 2025, intensity modulated radiation therapy (IMRT) will be added to the scope of our Post Payment Complex/Clinical Audit (PPCCA) program, supported by our vendor, Performant Recovery, Inc. (Performant).
You must complete our DSNP MOC 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.
Reminder to complete our D-SNP 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.
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.
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.