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  • Provider Center: Medical policy development

    The research and formulation of written medical policies supports medically appropriate and cost-effective health care services. The process includes identification of medical services, technology assessment, or coverage issues requiring a new or revised written medical policy. A comprehensive review of the identified issues is done and the medical policy documentation is developed utilizing several criteria.

    www.priorityhealth.com/provider/manual/standards/utilization-management-program/medical-policy-development

  • 09/03/2021 Provider news: Home care policy update

    Below are links to the updated Home care policy. Remember, you can always find the latest updates to policies in the Pending/retired/updated medical policy list.

    www.priorityhealth.com/provider/manual/news/standards/09-03-2021-home-care-policy-update

  • Provider Center billing: Medicare LCDs

    Priority Health Medicare applies Medicare medical policy as found either under National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs).

    www.priorityhealth.com/provider/manual/billing/clinical-edits/medicare-lcds

  • Agent center: Agent of Record policy

    Agent of Record policy and checklist for commercial and Medicare group plans.

    www.priorityhealth.com/agent/center/group/agent-of-record-policy

  • Provider Manual: Allergy injections

    Allergy injections/immunotherapy medical policy and billing information for providers

    www.priorityhealth.com/provider/manual/services/medical/allergy-injections

  • 06/12/2018 provider news: Opioids policy updated

    As of May 2018, Priority Health has updated its Opioid Management Policy to allow members using short-acting opioids for chronic (≥72 days of use in the last 90 days) pain management to fill 30-day supplies. Previously, all members were restricted to 15-day supplies.

    www.priorityhealth.com/provider/manual/news/pharmacy/06-12-2018-opioids-policy-updated

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