Southwest Michigan providers: Medicaid rebid changes do NOT impact Medicare 

Southwest Michigan providers: Changes impacting Priority Health Medicaid members resulting from the recent Medicaid rebid do not impact member eligibility for any other plan types, including Marketplace, Medicare, MAPD, D-SNP or Medigap plans. 

The rebid also does not impact your Priority Health network participation—it only changes the regions in which members can sign up with Priority Health Medicaid.

Southwest Michigan providers: Do not turn away any Priority Health members based on their plan type. Please continue to see new and existing Priority Health patients with any plan you participate with, checking their eligibility before you see them just as you did before. 

 

How do I check patient eligibility? 

To confirm that a patient is a current Priority Health plan member, use the Member Inquiry tool on prism. If you don’t have a prism account, you can check eligibility by calling the Provider Helpline at 800.942.4765, option 1. 

Again, the Medicaid rebid does not impact which members you can see. Continue to see any Priority Health member whose plan you are in-network for.

Does Priority Health still cover Medicaid members outside of Southwest Michigan?

Yes, Priority Health Medicaid is still in West Michigan and Metro Detroit. We also now offer Medicaid coverage in Northern Michigan (Lower Peninsula). See our service area map for exact counties. 

Can Southwest Michigan providers continue to see Medicaid members from other regions?

Yes, the rebid didn’t remove providers in Southwest Michigan from our Medicaid network, it only changed the coverage of member’s who live in that region. If you are part of the Priority Health Medicaid network in any region of the state, you can continue to see Medicaid members from anywhere in Michigan.

Is Priority Health Medicare covered everywhere in the Lower Peninsula of Michigan?

Yes, Priority Health Medicare plans cover members throughout the Lower Peninsula. There are no Lower Peninsula counties where we don’t cover Medicare members, including Dual-eligible Special Needs Plan (D-SNP) members who qualify for both Medicare and Medicaid. We also cover individual MyPriority members and employer group members throughout the entire Lower Peninsula. The Medicaid rebid did not impact member eligibility for any of these plan types.

Where can I go for other questions about the Medicaid rebid?

See our provider news update about the rebid for an overview and see our provider FAQs for more details.