Provider onboarding center
Whether you've just joined our network or you've been with us for a long time and are just looking for refreshers, we're thrilled you're part of the Priority Health family. Please bookmark this page and share it throughout your organization (especially with any new staff), so you and your team can refer to it frequently as you work with us.
This is a brand new page with more content coming. Check back soon.
Expand the drawers below to find the resources you need to start working with Priority Health.
Joining the Priority Health network
Ready to join the Priority Health network? Here's everything you'll need:
- Step-by-step instructions for joining
- The requirements and responsibilities of being in our network
- Contracting information
- Credentialing information
- Credentialing criteria by provider type
- Finding your network effective date
Need all this info in one convenient downloadable PDF? Here you go.
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 member eligibility
- Requesting authorizations
- Reviews and appeals
- Updating staff, names, addresses or phone numbers
- Risk adjustment and disease burden capture
Please also review our video library for tutorials on a variety of other topics.
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:
Out-of-state provider information
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
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
- Priority Health's Provider Helpline
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:
- The latest provider guide to Priority Health products
- A member-facing portal to our various plans across lines of business
- A breakdown of our three basic plan structures: HMO, POS, and PPO
- A visual description of our members' ID cards
- Information on our Cigna partnership (providing coverage for Priority Health members living or traveling outside Michigan)
Incentive program information
Our PCP Incentive Program (PIP) is a cornerstone of our relationship with providers. While most PIP information (including the manual) can be found in prism, you can read general information on the program in a recent news update here.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
New provider welcome emails
Missed our series of welcome emails? Click below for downloadable copies.
Tell us what you think
How is the Priority Health new provider onboarding experience? Let us know.
Test your knowledge
Want to see how you're doing? Take our new provider self-assessment and see which topics you need to brush up on.