Joining the Priority Health network
Joining the Priority Health network
Training topics
Training topics
Here are a few basic how-to guides for some of the things you'll need to do most frequently.
- Submitting a claim
- Checking the status of a claim
- Checking patient eligibility
- Requesting authorizations
- Reviews and appeals
- Updating staff, names, addresses or phone numbers
Please also review our Provider Education Modules page for short videos on a variety of other topics.
Staying in the loop
Staying in the loop
There are several ways of accessing the latest updates from Priority Health. Be sure to use one or more of the following resources to stay in the loop on updates that may directly affect you:
- Our provider news site
- Our quarterly newsletter (you are automatically subscribed once you create a prism account)
- Our provider webinars site for regular updates and tips on working with us
- prism notifications—simply log into your prism account and check your inbox by using the dropdown menu at the top of the page
Out-of-state provider information
Out-of-state provider information
If you are an out-of-state provider (outside of Michigan), start here for helpful information:
- For Medicare members
- For non-Medicare members (part of Priority Health employer group or individual)
Go-to tools
Go-to tools
Here are just a few of the tools you'll find most useful as a member of the Priority Health network. It may be helpful to bookmark them in your browser.
Getting your questions answered
Getting your questions answered
If you have questions and/or need assistance from the Priority Health team, please consult this document to determine how to approach the situation. Information is included on:
- self-service tools
- inquiries
- Priority Health's Provider Helpline
Priority Health products
Priority Health products
We have a variety of products in our various lines of business: individual, commercial, Medicare and Medicaid. Browse the following links for more information:
- Provider manual content about products that have specific provider requirements, including government programs like Medicare Advantage (MAPD) and Medicaid, as well as specialty commercial plans, including narrow networks, tiered networks and HMA, our TPA product
- Our Product Guide for Providers
- A breakdown of our basic plan structures
- Information on our Cigna partnership (providing coverage for Priority Health members living or traveling outside Michigan)
Incentive program information
Incentive program information
While most incentive program information can be found behind login on prism, you can check out these recent news updates for general information:
Does Priority Health have a provider portal, and what can I do through that portal?
Does Priority Health have a provider portal, and what can I do through that portal?
Yes! Priority Health does indeed have a portal specific to providers and provider organizations, groups and hospitals. This portal is called prism and it is your access to verifying member eligibility and benefits, submitting authorization requests, checking claim statuses, filing appeals and submitting other questions.
How do I create and manage a prism account with Priority Health?
How do I create and manage a prism account with Priority Health?
Priority Health has a page in our provider manual which was been created to show you how to register, navigate and manage your prism account. This page contains a quick start guide as well as FAQs and video tutorials to walk you through how to best leverage the tools available.
Where can I find resources regarding the process of adding providers to our group or changing our group information?
Where can I find resources regarding the process of adding providers to our group or changing our group information?
There are resources in our provider manual dedicated to adding or removing providers or changing practice information with Priority Health. These informational resources will advise you on how you can submit these change requests, as well as track the status of your request through prism.
How do I submit an authorization request to Priority Health?
How do I submit an authorization request to Priority Health?
Priority Health’s resources can advise you on whether an authorization is required for a certain service as well as how to submit your authorization request and track the status. See our provider manual for more information. Note that certain actions will prompt you to log into your prism account.
Does Priority Health Maintain a list of billing guidelines which I can utilize to ensure my claims meet processing requirements?
Does Priority Health Maintain a list of billing guidelines which I can utilize to ensure my claims meet processing requirements?
Our billing & payments page on our provider manual covers a wide range of topics from how to submit claims to Priority Health, what information needs to be included in a claim submission, corrected claim procedures and much more.
Once I have submitted my claim, how can I check on the status or file an appeal?
Once I have submitted my claim, how can I check on the status or file an appeal?
Prism is your go-to place to verify the status of your unpaid claims, or to confirm the payment details of claims which have completed processing. By logging into prism and selecting “Claims” from the navigation bar, you can search for member claims and verify these details. Have questions about your claim or need to file and appeal? Click on “Contact Us” at that top of the claim to submit a question or request to us. Your question will be reviewed and sent back to you through prism. You can also utilize prism to view your front-end-rejected claims. If you prefer to receive electronic service receipts for your rejected claims you can register for our electronic data interchange (EDI) service here.
How do I register to receive payments through Electronic Funds Transfer (EFT) rather than receiving paper checks?
How do I register to receive payments through Electronic Funds Transfer (EFT) rather than receiving paper checks?
Prism contains an EFT request form in the "Resources" selection of the prism navigation bar. Just click on Resources and select “Set up EFT." If you would like to review Priority Health’s informational details about EFT, you can click on “Set up electronic funds transfer” in the billing and payments section of our Provider Manual. For more information, visit our provider manual.
Does Priority Health leverage a data exchange for electronic files and reports?
Does Priority Health leverage a data exchange for electronic files and reports?
Yes. Priority Health has a data exchange called Filemart where you can access various data files. Visit our provider manual to review setup for Filemart and for information pertaining to setting up and accessing EDI files.
How do I know when to reach out to Priority Health or to my provider group/organization/network?
How do I know when to reach out to Priority Health or to my provider group/organization/network?
Any questions related to contracting (including rates), provider enrollments/changes or incentive payments should go through your organization. Anything related to service or payment at the level of your specific building/entity within the organization should be directed to Priority Health. Consult our "Get your questions answered" document for more details.
What are the best times to call the Provider Helpline to avoid a long wait?
What are the best times to call the Provider Helpline to avoid a long wait?
The busiest times for the Provider Helpline tend to be between 10:00–noon and between 2:00–4:00. So call early (we start taking calls at 7:30 Monday–Thursday and 9:00 on Friday) or between noon–2:00 for the shortest wait times. However, you can also avoid the wait entirely by checking the "Get your questions answered" document and finding what you need without picking up the phone.
What are some of the member programs you offer that I can refer my patients to?
What are some of the member programs you offer that I can refer my patients to?
We have numerous member programs to help supplement the care you provide our members. See a full list of the member programs we offer here.
How do I find my network effective date?
How do I find my network effective date?
Your network effective date will come through a comment in prism. (An email will let you know a new comment has been posted.) You can start seeing Priority Health members on this date.
What are the rights and responsibilities of Priority Health members?
What are the rights and responsibilities of Priority Health members?
Our site lists all member rights and responsibilities.
Where can I learn about a Priority Health member’s right to file grievances and appeals?
Where can I learn about a Priority Health member’s right to file grievances and appeals?
Priority Health members have the right to file requests, complaints, grievances and appeals. Learn more here.