Change an existing medical authorization

The following requests for changes can be made to existing Priority Health pending or approved non-drug medical authorizations. We'll process your change request within 3 days. For eviCore authorizations, call eviCore Client Services at 844.303.8456.

  • Change in date of service or DME rentals
  • Change in units, visits or days
  • Change provider or facility
  • Request to void a pending or an approved authorization

Limits to changing an existing medical authorization:

  • Adding or updating procedure or diagnosis codes requires a new authorization
  • No changes can be made to a denied or voided authorization
  • If you'd like to withdraw a pending authorization, use GuidingCare to request authorization withdraw

How to change your authorization request

Participating providers (in-network) and Non-participating providers (out-of-network) with a prism account

  1. Log into prism
  2. Click the General Requests tab
  3. Select New Request
  4. On the next screen, select the appropriate Authorization Change based on your request
  5. Scroll down to the bottom of the box to select Next
  6. Follow the prompts to submit your request.

You'll see your request and responses within prism on the General Requests page. 

Non-participating providers (out-of-network) without a prism account

Fax the medical authorization form with the following information:

  • Member name
  • Date of birth 
  • ID number
  • Authorization number
  • Change being requested

Access the Medical/service/device authorization forms here.

Fax numbers

  • Inpatient: 616.975.8858
  • Post-acute inpatient: 616.975.8848
  • Pre-service/outpatient: 888.647.6152

Drug authorization changes

A new authorization may be required for changes to previous drug approvals. This includes changes to dates, dose, frequency, administration, location, etc. Review drug coverage and utilization management rules prior to submitting a request for a drug authorization change.

eviCore

To make any changes to an eviCore authorization, including high-tech imaging or lab and genetic services, contact eviCore Client Services at 844.303.8456.