Organizational provider credentialing and screening

The organization types listed below must be credentialed or screened prior to seeing Priority Health plan members - this includes completing the requirements listed below and receiving our approval. If you don't see your organization type listed below, you're considered a "standard provider group" with us and don't require an organization application.

Organizations that require credentialing or screening

The organizational providers listed below are required to complete our credentialing and screening process before accepting Priority Health patients seeking in-network services. This is the full list of practitioners that require a prism application.

Most credentialed organizations don't need credentialing for individual practitioners. Review our credentialing criteria by provider type to determine if we require your practitioners to complete individual provider applications to become in-network.

Credentialed organization types

  • Acute Rehab Facilities
  • Behavioral health facilities
  • (Should be submitted via the New Organizational Provider Enrollment only if they're accredited or able to provide proof of a successful CMS survey. If they're not accredited and don't provide CMS survey documentation, please submit all individual practitioners via a New Individual Provider Enrollment)

  • Freestanding ambulatory surgery Facilities (ASF)
  • Sleep disorder clinics
  • Community-based health centers
  • ESRD providers
  • Federally qualified health centers
  • Home health care
  • Home infusion
  • Hospices
  • Hospital
  • Laboratories
  • Long-term acute care
  • Rehab facilities (PT, OT, ST)
  • Retail health clinics
  • Rural health clinics
  • School-based health clinics
  • Skilled nursing facilities (SNF)
  • Tribal health clinics
  • Urgent care facilities

Non-credentialed (screened) organization types

  • Ambulance
  • Anesthesiology
  • Audiology (hearing screenings, hearing aid suppliers)
  • Diabetic prevention program
  • Durable medical equipment (DME)
  • Emergency medicine
  • Health department
  • Independent diagnostic service
  • Pathology
  • Prosthetics/orthotics
  • Radiology/imaging center

Credentialing and screening process

We use an automated submission process for our credentialing form. Learn more about this process by reviewing these prism materials.

To credential your organization:

  1. Log in to your prism account (Don't have an account? Register here.)
  2. Click Enrollments & Changes
  3. Click New Organizational Provider Enrollment and follow the steps as indicated

    Note: For credentialed organizations, this application must include current accreditation and current professional and general liability insurance coverage. If you don't have a contract on file, a contracting team member will reach out to secure a contract.
  4. Include a completed IRS form W-9, Taxpayer Identification and Number Certification.
We'll send you a comment in prism with your inquiry number, any next steps as well as any requests for additional or missing information. You'll also receive a comment with your network effective date. All comments posted in prism will trigger an email notification.