How to use prism, your provider account with Priority Health

Creating an account

To keep your provider data and our member data secure, Priority Health uses ID.me to verify you are who you say you are. All users must be verified through ID.me to register for a prism account.

Learn more about ID.me

Note: Google Chrome is the recommended browser for prism.

Step 1: Verifying your identity

1. From the login screen, select Register for Provider Portal.
2. Select Verify with ID.me. You’ll be directed to ID.me to either login to an existing ID.me account or create a new one.
   
   See step-by-step instructions for registering with ID.me.
3. Once you’ve been verified through ID.me, make sure to allow Priority Health access to your verified identity information. You’ll automatically be redirected back to prism to continue the registration process.

Having issues getting verified? See our FAQ for ID.me.

Step 2: prism Registration

1. Select yes or no if you are a physician. Administrative staff or any user who isn’t a physician must select no.
2. Enter the required fields, including your Group Tax ID and Group Type 2 NPI.
3. Use an email associated with your employer when registering for an account.
4. Click next.
5. We’ll match the Group Tax ID and Group Type 2 NPI to the data we have in our system. If we’re unable to match a provider record, you’ll receive a notice on your screen that indicates the Tax ID and NPI combination is either inaccurate or can’t be found in our system. This may be due to a few reasons, such as you’re a new provider office or group, or your office hasn’t previously submitted any claims. You can still submit your prism registration with limited access until you’re either enrolled, or have added a valid Tax ID and NPI combination to your account.
6. Review. If your provider information is found, you’ll see it listed on the screen. Select submit.
7. Check your email to complete your prism registration, including setting a password.
8. Complete your profile by selecting your primary role and provider specialty type, along with your communication preferences. Click submit.

Note: prism applications may take up to five business days for approval. Any provider groups or facilities you requested access to are a separate approval from your prism account application. Please allow an additional two days for this review. You’ll receive a separate email once your access is approved by the provider group.

Managing your group or facility

In order to access a provider group or facility’s data such as claims, authorizations and enrollments, you’ll need to add them to your prism profile.

Note: all provider affiliations must be approved by the prism Security Administrator (pSA) before they appear in your prism account.

Adding a provider group/facility

1. Select your name on the top right corner of your account, and select profile.
2. The affiliation you registered with prism should appear under your list of affiliations.
3. To add a provider group/facility affiliation, select the green button indicating this on the screen.
4. Enter the Group Tax ID and Group Type 2 NPI of the group you want to add and then submit.

Your application for access will be sent automatically to the prism security administrator. Please allow up to five business days for this review. You’ll receive an email when approved. If access hasn’t been granted, you can follow up with the pSA by going to your profile, and selecting Follow up with pSA in your list of affiliations.

Deleting a provider group/facility

1. In your profile, under your list of affiliations, find the affiliation you want to remove and use the scroll bar at the bottom of the table to scroll to the far right.
2. Select the trash icon to remove the affiliation from your prism profile. Confirm you want to delete the provider.

Changing your dashboard view and affiliation

1. On your homepage, click on the provider group/facility listed at the top of the page.
2. Select Change Group / Facility.
3. In the table, check the box next to the vendor number you want to view, and then select Confirm.

Your dashboard, including claims, enrollments and appeals will now be changed to the group you selected. You may change this view at any time.

Reviewing claims and appeals in prism

Viewing claims

1. Select Claims at the top of your prism homepage, then select medical claims. You can also select view claims at the bottom of the pie chart on your dashboard.
2. Search by claim number, by a member contract number, or for front-end rejected claims, just select a date range and click search.

Once the claim detail appears, you can take further action by selecting Contact us about this claim.

For more detail about submitting claims and billing, visit Billing & payment.

Viewing and submitting an appeal

1. Select Appeals at the top of your prism homepage. You’ll see any appeals that are in process.
2. In the appeals table, you can select or search an existing appeal by the following: Appeal ID, Contract number, Patient name or Claim number.
3. Select the Inquiry ID to see the status and additional details of the appeal. You can leave a new comment or upload any files requested from our team.

From the appeal detail page, you can view an appeal status, appeals decision, upload requested files, or add new comments in response to inquiries from our provider team. This information can be viewed and used by anyone linked to your provider group.

From this page, you can submit a new pre-claim appeal, otherwise known as a pre-service appeal, or a post-claim appeal.

For more information and help, visit Review & appeals in the Provider Manual.

Provider enrollments & changes

1. Select Enrollments & Changes at the top of your prism homepage.
2. To submit an enrollment request for an Individual Provider Enrollment, Organizational Enrollment, or to submit a demographic change for an individual provider or organization, select the appropriate button and complete the form.

For detailed instructions on how to enroll and credential through prism, visit the Provider Manual.

Status your enrollment

1. You can access enrollments that are in process by clicking on Recent Enrollments on your prism dashboard, or clicking Enrollments & Changes at the top of the page.
2. Click on the Inquiry ID to see the status of the enrollment and comments from our provider team. If more information is requested by our team, you can upload files and add comments to respond to those requests.

General Requests

Need to get in touch with us? Send a request by choosing a category, and your inquiry will be sent to the right team.

To view comments and status on all your inquiries:

1. Select General Requests at the top of your prism homepage.
2. Select the Inquiry ID to view the details of the inquiry. You can view any comments from our provider team, upload files requested and leave comments for our team.