Provider webinars

January 30: billing & coding

• Navigating our Provider Manual & helpful resources
• Understand how your claim processed and why, right in prism
• Most common clinical edits we see applied to claims
• Asking a question about or disputing a clinical edit
• Submitting corrected claims
• 2025 telehealth billing updates

February 20: product tips & reminders

• Finding Priority Health product information
• Servicing HMA members with Priority Health's TPA product
• Seeing Cigna members in Michigan through Priority Health's Strategic Alliance
• Understanding HIDE SNP, a new integrated plan replacing D-SNP
• Reviewing Medicare benefits, including Galleri, Carallel and Extra Help

March 20: Medicare & Medicaid quality

• Medicare and Medicaid member supplemental benefits
• Medicare and Medicaid member incentives, including an overview of our new Medicaid maternal health incentive
• Information on our 2025 CAHPS and HOS campaigns 

April 17: billing & coding (with credentialing & enrollment tips)

• Credentialing and enrollment tips: How to set up a new group, add a provider to an existing group and update provider information
• Clinical edits and misused modifiers: The most commonly seen clinical edits and misused modifiers and how to correct these issues and bill appropriately
• Behavioral health billing: Ensuring your staff is credentialed appropriately, getting authorizations when necessary, coding diagnoses to the highest specificity and more
• Ambulance billing: Tips and reminders for successful ambulance billing

May 15: quality & behavioral health

• The behavioral health team at Priority Health: Who we are and what we do, Teladoc Health Mental Health and resources for providers and members
• Medicare quality: The Health Outcomes Survey (HOS), 2025 new Star rating measures and medication adherence reports
• Medicaid quality: The Priority Health Medicaid Health Journal, pediatric quality updates and maternal health updates

June 12: mid-year pharmacy & product updates

Pharmacy updates:

• June 1 Stelara coverage changes
• July 1 formulary changes
• An overview of our process for submitting requests for drug coverage authorizations

Product updates:

• Ayble: a virtual digestive health support platform
• Virta: digital resources for type 2 diabetes management and sustainable weight loss
• In lieu of services (ILOS): food delivery services for some Medicaid members

June 26: supplemental data submission

• Understanding our supplemental data strategy and available submission methods
• Using data feeds (i.e., MiHIN, APS, HL7 and EPP) to submit supplemental data, including how to appropriately set up an HL7 / APS data feed
• Submitting medical records through SharePoint, including updated file naming conventions to support smoother record processing for gap closure
• Signing up for Cognizant’s Provider Registry, including why it may be useful for your practices’ workflow and how to navigate the tool

July 10: billing & coding

• Clinical edits we commonly see applied to claims and coding tips to avoid them
• Modifiers that are commonly misused and how to use them appropriately
• Medically Unlikely Edits (MUE) denials and how to interpret adjustment indicators for each HCPCS/CPT code
• Unlisted codes billing and how to get them processed on the first submission
• Corrected claims and how to submit them
• prism navigation and resources to help you find what you need and get your questions answered

August 21: Medicare & Medicaid quality

• Preventive care for Priority Health Medicare members
• Falls Prevention Awareness Week 
• 2025 Medicare at-home testing campaigns
• Medicaid tips for HEDIS success
• Hepatitis C screening information
• Supporting inclusive patient care with SOGIE (Sexual Orientation, Gender Identity & Expression) data collection 

September 25: billing & coding

• Remittance advices – access for you and third-party billing companies
• Tips on coding quality and coding for gap closure
• Claim disputes: what we’re looking for
• Billing policies overview

October 23: PCP Incentive Program (PIP) updates

• 2026 PCP Incentive Program (PIP) overview
• Tips for success in the 2026 PIP program
• Tips to improve gap closure and increase incentive earnings 

November 20: Pharmacy and product updates

• Pharmacy updates
  • Commercial formulary changes 
  • Medicare formulary changes 
  • Medical/Part B drug list changes 
• Product updates
  • PriorityMedicare Dual Premier, Priority Health’s HIDE-SNP plan
  • Medicare product updates
  • Boulder Care: A New Substance Use Disorder care and support platform for employer group members
  • Other commercial product updates

December 9: Medicare & Medicaid quality

• Telehealth visits for your Medicaid patients
• 2025 CAHPS survey results
• 2025 Medicaid Maternal Health Incentive Program outcomes
• Preparing for the 2025 HEDIS audit
• Quarter 4 push to close care gaps
• Open forum: How can we better support your quality efforts in 2026? 

December 16: 2026 Disease Burden Management (DBM) program

• An overview of the Disease Burden Management Program (DBM)
• What's changing in 2026 DBM
• Tips to help you succeed in DBM

February 2024 (52 min.)

• prism inquiry tips: When and how to reach out to our team
• Community Care Management (CCM): Program purpose and highlights, member eligibility criteria, CCM provider partners, new substance use pilot program, referral process and provider resources
• New updates to the member Cost Estimator tool: How to access the Cost Estimator tool in prism, provider FAQs, tips on navigating the tool and provider resources
• PriorityBABY: Program details, objectives and how to share information with patients.
• Medicare and Medicaid quality updates: Medicare annual CAHPS survey updates, 2024 priorities (pharmacy medication adherence, care coordination measures, ECDS and Health Equity) and pregnancy management for Medicaid members
• Disease burden management program updates: How ACNs can earn incentives, member qualifications for DBM and provider resources
• 2024 PCP incentive program updates: 2024 measure updates and our Digital First Strategy
• Patient discharge: the new process in prism: How to discharge patients from their assigned PCP in Member Inquiry

April 2024 (54 min.)

• Billing and coding policies
• Multiple same-day procedure (MSD) billing
• Durable medical equipment (DME) billing
• Doula billing
• Q11 claim denials
• Seeing Cigna members in Michigan
• How to report additional diagnoses on claims
• Hierarchical condition categories (HCC) coding for the disease burden management (DBM) program

June 2024 (65 min.)

• prism: new prism communications tools and prism Security Administrator (pSA) renewals
• Pharmacy: July 1 formulary changes and information on a new member discount program: PriceMyMeds
• Behavioral health: credentialing tips and virtual member support with Teladoc Mental Health
• Quality: medication adherence reports and the Medicare Health Outcomes Survey (HOS)

2025 PIP program overview (23 min.)

• A new Access to Care measure, supporting increased efforts to engage your hardest to reach patients
• Care Management monthly PMPM payment, replacing focus measure pre-payments
• Preventive, chronic disease management and Medicare 5-Star measures maintained from 2024
• New disparity measures, addressing differences and/or gaps in health care across racial, ethnic and socio-economic groups

Q4 quality campaigns (27 min.)

• Closing patient care gaps through at-home screenings
• Medicare/Medicaid member outreach
• Medicare/Medicaid member incentives 
• Our annual patient care and coordination survey

2025 product updates (50 min.)

• Commercial group product updates, including the HMA third-party administrator (TPA) product, a new narrow network product called PriorityIntegra and a musculoskeletal centers of excellence rider
• Individual product updates and reminders about MyPriority narrow network plans
• Medicare product and benefit updates
• Medicaid rebid impacts

2025 Disease Burden Management (DBM) program (20 min.)

• Elements from the 2024 DBM program that will carry over into 2025
• What's changing in 2025, including 2 new program incentives
• How to be successful in risk adjustment and the 2025 DBM program

2025 Medicare & Medicaid quality updates (26 min.)

• An overview of our 2024 quality initiatives
• A look into quality's 2025 HEDIS areas of focus

January 1 formulary changes (29 min.)

• 2025 commercial and individual formulary changes
• 2025 Medicare Part D formulary changes
• Impacts of the Inflation Reduction Act (IRA) in 2025
• An overview of the 2025 Medicare Prescription Payment Plan (M3P)

December 2023 (44 min.)

• prism security: The pSA (prism Security Administrator) process for TPAs (third-party administrators), how practices can determine if their affiliation has a pSA and how to assign PSAs in prism 
• Pharmacy updates: Formulary changes, coverage changes for Humira and its biosimilars, RSV vaccine coverage updates, pharmacy specialty network updates and continuous glucose monitor core benefit changes 
• Medicaid quality updates: Information on pre-exposure prophylaxis, chronic kidney disease, doulas, lead screenings in children and vaccines for children 
• prism inquiry tips: Submitting inquiries using the Clinical Edits dropdown vs. the Other Related Claims dropdown in prism and submitting inquiries for issues impacting more than 10 claims 

October 2023 (48 min.)

• prism security updates: Information on prism security administrators (pSAs) and how to assign one
• Behavioral health updates: information on community care management (CCM) and our self-help mental wellness tool
• Medicare quality updates: Q4 member campaigns, 90-day prescription refills and 2024 CMS star ratings updates
• 2024 Priority Health product updates: Updates on group commercial, individual, Medicare Advantage and D-SNP products
• A 2024 PIP program overview: Updates, information about our digital first strategy and a sneak preview of our preliminary 2024 PIP Manual

August 2023 (38 min.)

• Behavioral health billing tips: Appeal submissions deadlines, limited license providers, changing locations and more
• Coding tips: How to use our Edits Checker tool effectively, virtual care billing, how to submit clinical edits questions and where in prism to review front-end rejections
• Appeals tips: An overview of pre- vs. post-claim appeals, what to include with your appeal and working with third-party appeal companies
• Pre-service organization determinations: When you need them and how to request them

June 2023 (48 min.)

• July 1 formulary changes: Drug and continuous glucose monitor changes
• PHE ending: How the end of the Public Health Emergency (PHE) impacted member coverage and virtual care billing
• GuidingCare: Updates to our prior authorization portal, including new helpful pop-ups
• Medicaid quality updates: Provider resources, Health Risk Assessment (HRA) incentive, lead screenings and immunizations
• Medicare quality updates: Health Outcome Survey (HOS), annual physical exams, member rewards, tips for keeping members adherent and more

April 2023 (25 min.)

• Top 5 denial reasons of 2023 so far and how to avoid them
• How to get your Priority Health questions answered and how to submit your inquiries in prism, with real life examples
• Fee schedules and how to find them
• Appeals tips for non-contracted Medicare providers
• Behavioral health credentialing and enrollment tips

February 2023 (32 min.)

This webinar is a great resource if you’re new to the Priority Health network or need a refresher on the online tools and resources available to help you work with us.

We show you how to:

• Get important news and updates
• Find the most requested information on our website
• Access training videos, news archives and more

December 2022 (35 min.)

• January 2023 formulary changes
• 2023 E/M coding changes
• Provider tool spotlight: (1) Best practices for credentialing, billing, payments and prism (2) Top reasons for claims denials and how to avoid them

October 2022 (60 min.)

• New products/updates: Regulatory product updates and new, innovative products focused on integrated benefit navigation and accessible care coordination
• Medicare quality and 2023 products: End-of-year quality pushes and new Medicare products
• 2023 PIP updates: Learn about the 2023 program

August 2022 (40 min.)

• 2021 Quality Awards: Congratulating our winners
• prism spotlight: Review how to submit claims and appeals through prism to increase response time
• Medicare quality: 2022 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results
• Behavioral health: Resources to support your patients during Suicide Prevention Awareness Month
• GuidingCare upgrade: Addition of peer-to-peer medical review requests through the authorization portal and the update to InterQual® 2022 on Aug. 22, 2022
• Value-based programs: Key PCP Incentive Program (PIP) updates and deadlines

June 2022 (30 min.)

• Pharmacy: July 2022 formulary changes
• Quality: Statin Star measures: Tips for keeping patients adherent, monthly adherence reports to get the most from our PCP Incentive Program and ICD-10 codes for intolerance
• Risk adjustment: Coding and documentation for depression/major depressive disorder, morbid obesity and social determinants of health, to help you manage better outcomes for your patients and earn incentive dollars through our value-based programs
• Member programs: PriorityMOM update

April 2022 (30 min.)

• Coding and billing tips for Medicare & Medicaid
• Value-based program updates, including PCP Incentive Program (PIP) patient attribution, Patient Profile, PRA attestation and more
• RETACRIT supply disruption beginning in May
• Right Price Rx, our new pharmacy savings program for commercial members

February 2022 (45 min.)

• Medicare 5-Star measures included in the 2022 PCP Incentive Program (PIP)
• Credentialing and enrollment in prism
• Supporting your patients with eating disorders
• Answers to common Cigna Alliance questions
• Coding and documentation for diabetes

December 2021 (45 min.)

• 2022 formulary updates, Medicare and commercial
• 2022 prior authorization changes
• Prism tips
• Appeals changes
• Coding and documentation for risk adjustment
• Prism enhancements coming Dec. 14, 2021

October 2021 (60 min.)

• New products and product updates for 2022, including D-SNP plans, commercial products and Medicare products
• 2022 PCP Incentive Program (PIP) manual and updates
• Tips to help close gaps in care this fall
• Latest updates for prism

August 2021 (45 min.)

• Prism, your new provider account coming this September
• Your patients, our members, one Five-Star quality experience
• Changes to our musculoskeletal authorization coming Jan. 1, 2022
• THC providers can now register for Priority Health onboarding
• GuidingCare enhancements coming Aug. 23, 2021
• Congratulating our 2020 Quality Award winners

June 2021 (30 min.)

• July formulary changes
• New provider information form submission process
• Updated secure mail options to help you get your questions answered quickly
• New tool to help you support patients in finding community resources
• New tools for your patients - Priority Health Connect

April 2021 (45 min.)

• New provider portal coming soon
• Integration with Total Health Care
• Reminder: Deadline to join a PO for 2022 PIP participation approaching
• Most common causes for billing denials and tips to avoid denials
• Benefits of our new APM Roster app for PIP participating providers

February 2021 (45 min.)

• Updates to the provider information form used to request demographic changes and more
• Coming soon: Automation for provider information submissions
• COVID-19 vaccine reimbursement information
• 2021 PCP Incentive Program (PIP) updates

December 2020 (31 min.)

• How to credential nurse practitioners and physician assistants
• 2021 E/M billing changes
• How to review a claim using our claims inquiry tool
• Supporting you and your patients during COVID-19 in 2021

November 2020 (54 min.)

• January formulary updates
• Behavioral health platform: MyStrength
• The importance of lead screening
• Learn about Priority Health and Cigna Strategic Alliance and serving Cigna members in Michigan
• Top causes for billing denials and tips to avoid

October 2020 (1hr. 8 min.)

• New products and product changes for 2021, including, updates for our DSNP plans, commercial product updates and Medicare product updates. 
• 2021 PIP manual and updates

September 2020 (25 min.)

• The launch of a new authorization tool for inpatient, select procedures, behavioral health, SNFs and home care
• How to add providers to PO/PHO contracts
• New electronic pharmacy auth tool available: ePA Pharmacy
• Tips and tricks for billing Medicare therapy caps

July 2020 (27 min.)

• Medicare 5-Star challenge and how to achieve 5-star quality
• Our new authorization tool, coming soon for inpatient, select procedures, behavioral health, SNFs and home care
• Tips for coding and billing COVID-19 care

May 2020 (36 min.)

• July 1 commercial formulary updates
• PCP Incentive Program: 2019 and 2020 program updates
• COVID-19: Supporting you and providing the latest information

March 2020 (25 min.)

• How to use the secure email box to compose messages
• Step-by-step guide through the new appeals process
• Medicaid programs explained 

January 2020 (25 min.)

• Upcoming commercial and individual benefit changes for outpatient therapy to prevent post-partum depression
• Billing for maternity care
• Tips for billing preventive services

December 2019 (18 min.)

• Standard practices for billing bilateral diagnoses
• Appropriate modifiers to use for Evaluation and Management (E&M) codes
• Updates to our provider secure email system and our claims inquiry tool
• Provider information form updates: What’s changed and why you should use the updated form

November 2019 (27 min.)

• January 2020 formulary changes
• Fee schedule updates for hand surgery
• Coming soon: View front-end rejections on the provider portal

October 2019 (38 min.)

• Medicare Advantage plan updates
• Commercial plan updates
• New: PriorityMedicare D-SNP plan
• 2020 individual product updates

September 2019 (56 min.)

• January 2020 formulary changes
• New 2020 Health Risk Assessment (HRA) and Healthy Behavior requirements for Healthy Michigan Plan members
• AHA visits and what you need to do before the year’s end
• Tips and tricks for PIP program success 

August 2019 (34 min.)

• How to term and add providers to your practice using the provider information form
• Updating your information on the Council for Affordable Quality Healthcare (CAQH) provider data base
• The most common causes for billing denials
• Common clinical edits and how you can submit an appeal for review

July 2019 (32 min.)

• Community Health Automated Medicaid Processing System (CHAMPS) requirements and enrollment
• Key gaps in care
• The Medicare 5-Star challenge and how to achieve 5-Star quality
• Our annual provider survey
• What you need to know about in our recent news highlights

June 2019 (28 min.)

• How to get your questions answered quickly at Priority Health
• The most common causes for billing denials and tips to avoid denials
• Common code edits and how you can submit an appeal for review

May 2019 (21 min.)

• Formulary changes coming July 1
• Patient eligibility for our Medicaid member diaper incentive program
• New Medicaid Tobacco Cessation outreach and Quitline initiatives

March 2019 (45 min.)

• Coding requirements
• Life cycle of a question at Priority Health
• Coordination of benefits
• Medicaid third party liability
• Medicare STAR rating and CAHPS
• HOS surveys

February 2019 (60 min.)

• New member discharge policy
• Reimbursement of payable drugs and biological agents require modifier
• New online provider portal manual layout

December 2018 (60 min.)

• Risk adjustment encounter data
• PIP 2019 program
• Thyroidectomy medical policy change
• Orientation to the Priority Health website

November 2018 (55 min.)

• Clinical updates
• Colorectal cancer screening tests
• Blood pressure best practices
• Medicare authorizations and organization determinations
• New product offerings

October 2018 (55 min.)

• Formulary changes
• Home Health upcoming changes 
• Chiropractic changes

August 2018 (41 min.)

• In-home health assessments
• eviCore authorizations relaunch
• Provider directory requirements

June 2018 (50 min.)

• Overview of Clear Coverage®
• eviCore update
• Comprehensive authorizations Q&A

April 2018 (43 min.)

• Pharmacy and formulary changes coming July 2018
• Clear Coverage™ prior authorization tool overview

February 2018 (40 min.)

• Risk adjustment impact for providers
• Priority Health Academy events
• Care management and incentive programs

January 2018 (33 min.)

• Top 5 reasons for inquiries to Provider Services
• Fee schedules - where to find them and how to interpret them
• Payment take backs and reconciliations
• New provider relations education staff
• Call center scope change