Priority health medicare advantage provider phone number

If you're a Michigan provider interested in joining our network, see our service area maps and follow the steps outlined below. It can take up to 90 calendar days for us to process your enrollment request.

Step 1: Confirm your process

Your process for becoming an in-network provider with us depends on your specialty and whether you're affiliated with an organization with an active Priority Health contract.

Before applying online, we recommend you review:

• PO / PHO organizations with active contracts with us.
  If you're working with one of these organizations, contact its internal administrator first. They may handle your application for you.
• Our requirements for behavioral health providers, organizational providers and other provider types. 

Step 2: Register with CAQH® (if you haven't already)

Before you can apply to become an in-network provider, you must first be registered with Council for Affordable Healthcare (CAQH) Proview™ and make sure your information is up to date there.

You can: 

• Register with CAQH online or
• Call them at 888.599.1771.

Step 3: Apply online

Once you are registered with CAQH Proview™ and determined you require an application to join our network:

1. Register for prism, our online provider tool, or log into your existing account.
2. Click on Enrollments & Changes and select the appropriate enrollment type.
   Learn more about how to complete the application.
   If you're a behavioral health provider, see our behavioral health provider participation instructions.
3. Complete all fields and click Submit.

After you submit your application, you'll receive an inquiry number and can check the status of your application and submit questions through your prism account.

When you complete our online application, you consent to release your CAQH information to us.

Step 4: Wait until you receive your network effective date

Once you submit your application, we’re working hard behind the scenes to get you set up and ready to see our members. Once we’ve completed everything on our end (see below for an overview of our process), we’ll send you a message in prism with your network effective date. Until then, you shouldn’t see Priority Health members seeking in-network care from Priority Health providers.

Our process, once we receive your application

1. Contracting: Every provider must be under contract with us before they can be in our network. Learn more about provider contracts and agreements.
2. Credentialing: We ensure providers meet our criteria to be approved as in-network by verifying licensure, malpractice coverage or claims, education and specialty training. Learn more about provider credentialing.
3. Enrollment: Once credentialed, we enroll providers in our systems.
4. Reimbursement: We configure each provider's reimbursement structure based on their contract.

How does out-of-state coverage work?

Most Priority Health Medicare Advantage plans include coverage outside of Michigan. When a member with one of these plans sees a provider outside of Michigan who participates with Original Medicare or is included in the Multiplan Medicare Advantage network, we'll cover those services at the in-network benefit level.

And, the back of the card will include a MultiPlan logo. They are not limited to providers in the MultiPlan Medicare provider network.

Members will also receive a Travel Pass card that they may show you. We value the care you provide our members while they're out-of-state and want to make sure working with us is easy and convenient. Follow the directions on the Travel Pass card to learn more about the member's ID card and how to submit claims.

Rest easy knowing your claims will be paid.

As a Medicare-participating provider, you can have peace of mind knowing you'll be reimbursed for the services you provide our Medicare Advantage members while they're away from home. 

• We reimburse providers at the National Medicare Physician Fee Schedule allowed rate, using the associated relative value unit (RVU) file provided by the Centers for Medicare and Medicaid Services (CMS).
• We process claims quickly. In 2020, our average processing time for claims was within 7 days of receipt.
• We send payments in the way that's most convenient for you. We process and mail hard-copy checks weekly. We also offer electronic funds transfer (EFT) for even quicker payment. Review our EFT requirements and get set up.

Register for a prism account

When you create a prism account with us, you'll get access to our Member Inquiry tool. This tool is a quick, self-service option that lets providers check patient eligibility and see important plan information without having to call our provider helpline. You don't need to be a contracted Priority Health provider to create an account.

With an account, you'll be able to:

• Check eligibility and contract history
• See out-of-pocket limits, deductible balance(s), copays and coinsurance
• Check the status of claims quickly

Register for prism

Is Priority Medicare an Advantage plan?

Is Priority Health owned by Spectrum Health?

Is Priority Health only in Michigan?

What is Papa with Priority Health?