Total Health Care (THC) integration information

Use this page as your main resource for all Priority Health THC integration news. We'll post current news items here, as well as list out all necessary resources to ensure you and your practice are ready for the transition to Priority Health.

Current integration news

(Sep. 20) Priority Health provider training for THC providers is available on demand

(Jul. 2) THC providers new to Priority Health: Register for provider training and onboarding

(May 3) We're welcoming Total Health Care to Priority Health

Transition timeline

Date Action
 May 1, 2021  THC will adjust their commercial claim filing limit to 180 days. The Medicaid filing limit will remain at 365 days.
 Jun. 17, 2021  THC provider organization Q&A meeting -View the meeting slide deck.
 Jul. 2, 2021  THC providers new to Priority Health: Registration open for provider training and onboarding
 Aug. 2021  THC Medicaid members will be notified through MDHHS of their plan change.
 Aug. 1, 2021  THC commercial members begin to transition to Priority Health plans as they renew their medical coverage. This process will continue through July 2022.
 Aug. 1, 2021  THC providers are added to Priority Health's Find a Doc tool for members shopping for 2022 coverage.
 Aug. 5, 2021  THC provider organization Q&A meeting - View the meeting slide deck.
 Sep. 29, 2021   THC provider organization Q&A meeting - Capitation  
 Oct.1, 2021
 THC's Medicaid plan transitions to Priority Health Choice.
 Jan. 1, 2022  THC group and individual plans fully transition to Priority Health products.

Look for additional key dates to be shared throughout 2021.

Why are we making this change?

We want to make sure we're continuing to keep care affordable and accessible by maintaining long-term sustainability while delivering viable solutions in the southeast Michigan market.

What are the benefits to THC providers?

Providers will gain access to:

  • Tools and platforms – We're upgrading the tools we use to support our provider network in 2021. You'll benefit from these enhancements, which will allow you to quickly update provider information changes in our Provider Roster Application (PRA), easily identifying gaps in care through our patient registry, and better understand your performance in key quality measures using Filemart.
  • Online and webinar communications – You'll have access to our digital content and education, including our Virtual Office Advisory webinars and much more.
  • PCP Incentive Program (PIP) – Starting January 1, 2022, you can earn incentive dollars for meeting key quality thresholds through our PIP program.
  • Patient panel growth – You'll transition to Priority Health participating providers for our members, including Medicare Advantage.
  • Specialty provider network – You'll experience greater accessibility to specialists for Medicaid patients through Priority Health's specialty and ancillary provider network.

You can learn more about this transition by reading the THC Integration plan FAQ.

What do providers need to do?

Total Health Care providers new to Priority Health: Register for Priority Health provider training and onboarding to learn how we can work together to best serve your patients and our members.

View a recorded training here.

How to best work with us

Question THC member Priority Health member
How do I know if my patient has Priority Health or THC as the primary plan administrator?
Your patient will have a THC ID card.
Your patient will have a Priority Health ID card.
What is the network and governing contract for reimbursement?
THC contractual terms and reimbursement apply.
Priority Health contractual terms and reimbursement apply.
How do I confirm eligibility or benefits for my patients?
  • Online at thcmi.com
  • Phone: 313.871-2000, prompt 2/4
  • Online
  • Within Michigan: 800.942.4765
  • Outside of Michigan: 833.300.3628
  • Electronic data interchange (EDI) clearinghouse
How do I submit claims?

Electronic: THC Payer ID 38201
Paper:
Total Health Care Inc, Michigan
P.O. Box 21485
Eagan, MN 55121-0486
Claim filing limits:

  • Medicaid – 365 days from DOS
  • Commercial – 180 days from DOS

Electronic: Use Priority Health payer ID 38217
Paper:
Priority Health Claims
P.O. Box 232
Grand Rapids, MI 49501

Who processes claims and issues the explanation of payment, explanation of benefits, or statement of account?

THC will continue to process claims for:

  • Medicaid for dates of service through 9/30/2021
  • Commercial for dates of service through 12/31/2021
  • Priority Health will process claims.
  • Visit our website for a detailed list of claim filing limits.
How can I review claim status?
  • Online at thcmi.com, or EOPs at Repay (formerly Ventanex)

313-871-2000 ext 3851

  • Online
  • Within Michigan: 800.942.4765
  • Outside of Michigan: 833.300.3628
How do I submit an appeal?

Appeals for both adverse benefit determinations (medical) and claims (administrative) must be submitted within 180 days from original denial date, and can be submitted orally by calling 313-871-2000, or in writing (include supporting medical documentation):

Via email: claims@thcmi.com

Via mail:
THC Appeals
3011 W Grand Blvd, Ste 1600
Detroit, MI 48202
See the Provider Manual for information on claims and authorization appeals by plan type.
Who do I contact for prior authorization or medical management services?
Continue to follow the prior authorization process as noted on the THC provider portal. Clinical documentation for the request must be faxed to 313-748-1312.
  • See the patient's ID card for instructions
  • Online
  • We've developed this chart to help you manage different authorization scenarios.
How do I request prior authorizations for high-tech radiology?
 Continue to process PCP generated referrals through the thcmi.com portal for THC enrollees.
 Login to your Priority Health provider account and request an authorization.