Provider contracts & agreements
By contracting with Priority Health, providers agree to abide by, comply with and participate in any and all policies and procedures of Priority Health and its plans.
- Once you are credentialed and your contracts have been executed, we’ll send you a notice welcoming you to the Priority Health network. This email will include your network effective date. You can begin billing for dates of service on the effective date. Claims submitted before the effective date may result in incorrect payment or denial.
- The agreement extends for one-year periods and automatically renews for additional terms unless terminated.
Priority Health doesn't apply effective dates retroactively. You should not see Priority Health members who are seeking in-network care from Priority Health providers until you receive notice from us that your request for network participation is complete, along with a network effective date. If you see a Priority Health member before you receive a network effective date, you must inform the member that your services are out of network. Claims submitted to us before you receive a network effective date will be denied as “care available in plan.”
Requesting medical records
Priority Health or authorized third party vendors, representing Priority Health, may periodically request access to or copies of Medical Records for a variety of business reasons.
Records may be requested for the purpose of, Medical Record or Billing Record reviews, HEDIS, care management or risk adjustment, as examples.
Medical Record requests, will be in accordance with the terms of the Participation Agreement between Priority Health and provider. Requests will be subject to all applicable laws and confidentiality provisions in the Agreement.
Priority Health prefers to work with providers to obtain needed Medical Records through a secure, remote EMR access or alternate electronic methods. Remote access options, to obtain needed Medical Records can prevent on-site retrieval that can be both inefficient and disruptive.
Providers who utilizes a vendor to produce copies of medical records are responsible for assuring that their vendor supplies requested Medical Records in accordance with the Participation Agreement between Priority Health and Participating Provider.
Cancellation or termination of physician contracts
All terms of cancellation, including how much notice is required, are in your contract.
Go to the process for notifying us when you retire, leave the area or otherwise terminate your participation with us.
- NPI numbers
- Electronic funds transfer (EFT)
- Physician status
- Open or close to new patients
- Availability standards
- Changes to address or staff
- Provider-patient relationship
- Medical & office records
- Medicaid patient treatment
- Medicare patient treatment
- Site visits
- Fraud, waste & abuse
- Utilization Management Program