prism inquiry turnaround times and when to reach out to our team

We frequently get questions about our turnaround times for various inquiries made in prism and would like to share the following.

prism inquiry turnaround times

• General requests: 30 days
• Informal claim review: 15 days
• Level 1 appeal: 45 days
• Enrollment (non-delegated): 80 days
• Provider changes / terminations: 30 days
• Coding / clinical edit review: 60 days
• Coding / clinical edit Level 1 appeal: 60 days

Please note the coding / clinical edit review and Level 1 appeal turnaround times have been updated to 60 days, to allow our teams sufficient time to thoroughly review the medical records and supporting documentation submitted with these inquiries.

What else do you need to know?

The turnaround times begin when the inquiry reaches the correct Priority Health team – make sure you’re selecting the most appropriate inquiry option in prism.

We ask that you:

• Wait the full turnaround time for a response before emailing us at exceedsprocessingtime@priorityhealth.com.
• Don’t request a status update by making a comment in an open inquiry. Our system will automatically reset your turnaround timeline back to the beginning – ultimately delaying your resolution time.
• Don’t open a new inquiry to request a status update on an already open inquiry. This will cause duplicates and delay processing.