Frequently asked questions for providers

For our provider partners, our collaboration will use the best capabilities of both organizations to give you a more predictable and simplified experience. We're working to collaborate and align processes to add value in areas that include clinical criteria, clinical edits, authorizations, appeals and more.

This will also give employers in Michigan more choices and access to affordable care for their employees.

Your practices don't need to do anything differently. When a patient presents their Priority Health or Cigna Open Access Plus® (OAP) ID card, simply follow any instructions for submitting claims, prior authorizations or calling for more information. Contact Priority Health for our members, and Cigna for Cigna members.

No. Cigna Open Access Plus® (OAP) members continue to have coverage through Cigna. The only change is that they have access to providers in Michigan through Priority Health’s PPO network.

No, this is a Strategic Alliance where Priority Health members will continue to have access to the Cigna Open Access Plus® (OAP) provider network when outside of Michigan and Cigna members will now access the Priority Health PPO network for care inside of Michigan. This relationship delivers a competitive network solution for Michigan employers based on shared capabilities and the strength of our provider relationships, but both companies will continue to operate independently.

If the patient has a Cigna Open Access Plus® (OAP) card with the Priority Health logo or is a traveling member with an Cigna Open Access Plus® (OAP) Away From Home Care logo, you should see them and bill following instructions on their ID card. Priority Health contractual terms and reimbursement apply, with a few exceptions in ancillary care. For Cigna members getting ancillary services like durable medical equipment, behavioral health home infusion, and vision Cigna's national ancillary agreements will apply. Questions regarding Cigna patients should be directed to Cigna at the number on the back of their ID card.

For providers who need to contract with Priority Health, they should follow the steps to joining our network.

You’ll be out-of-network for Cigna Open Access Plus® (OAP) members in Michigan.

No. If you’re a credentialed provider with Priority Health, you’re all set to serve Cigna patients in Michigan. Priority Health sends our participating provider information to Cigna bi-weekly. Cigna will not add or change providers unless it comes from us. They use our provider data for considering if a provider is in-network for their Michigan members. This also streamlines the process for our providers. You’ll only need to send changes to us.

Need to make changes? Update your information through prism.

Participating providers will display in Cigna’s Provider Directory.

If you’re already credentialed with Priority Health, there's nothing you need to do. You do not need to be credentialed with Cigna to see their Michigan members.

If you’re in Michigan and have a new provider joining your office, continue to credential with Priority Health following the same process you always have. You do not need to credential them with Cigna to see Cigna members in Michigan.

If you're contracted with Priority Health in Michigan's lower peninsula, you'll be able to continue seeing Cigna commercial members. You'll be reimbursed for Cigna members at the same rates you receive for your Priority Health members except for certain ancillary services. Cigna national ancillary agreements in place will supersede for Cigna customers.

For Cigna Open Access Plus® (OAP) members, they'll have access to Priority Health's PPO network as of January 1, 2021. If a provider is not in the Priority Health network by that time, they'll be considered out of network for Cigna commercial members.

The member is now in-network and the provider will be paid according to their Priority Health agreement.

When a patient presents their Cigna Open Access Plus® (OAP) member ID card, simply follow any instructions on the member ID card for eligibility, submitting claims, prior authorizations or calling for more information. Visit CignaforHCP.com > Patients. To use this tool, you must be a registered user with access to view patient information.

Cigna Customer Service: 800.88Cigna (882.4462).

Individuals with Open Access Plus® (OAP) coverage and a Cigna ID card access Cigna’s nationwide network. When they live in or travel to Michigan, they can access in-network care through Priority Health’s PPO network.

Our Strategic Alliance with Cigna uses our PPO network and applies to Cigna’s commercial group members. If you see other Cigna patients, such as a Cigna Medicare, Medicaid or Individual patient, and don’t have a Cigna contract for that product, the patient’s out-of-network benefits will apply.

Your Cigna patients can continue to see their providers if the provider is in the Priority Health PPO network. There will be no change for the patient.

There are approximately 120,000 Cigna members in Michigan. Most Cigna members in Michigan—about 80%--are on the east side of the state.

Yes. These Strategic Partners include:

• TUFTS Health Plan/CareLink
• HealthPartners
• MVP

Any health plans with access to Cigna Open Access Plus® (OAP) Network can use the Priority Health PPO network.

For more information about these Strategic Partners, including sample member cards, see Cigna’s online guide.

There's no change to how you request or status an authorization. See the patient's ID card for instructions. For Priority Health members, continue to use the Auth Request tool.

For Cigna members, log in to Cigna for Health Care Professionals > Patients > View and submit precertification. To use this tool, you must be a registered user with precertification access.

Visit Cigna for Health Care Professionals > Patients > View and submit precertification. To use this tool, you must be a registered user with precertification access. Or call Cigna Customer Service and 800.882.4462.

Cigna Open Access Plus® (OAP) members in Michigan will use Priority Health’s PPO network for ancillary care. eviCore healthcare® (eviCore) manages home health care, durable medical equipment (DME) and home infusion therapy for Cigna commercial customers. eviCore has a national network of providers who offer these services.

Exception 1: Behavioral health, transplants and optometry

For these services, Cigna members need to see a Cigna provider. Providers and members can search for providers on the Cigna Find a Doctor tool. ID cards may also display what company to call for certain services.

Providers must request a prior authorization if needed. For authorizations, providers can visit Cigna for Health Care Professionals > patients > view and submit pre-certification, or call customer service at 800.882.4462. Providers need to submit these claims to Cigna.

To find behavioral health authorization requirements and billing practices for Cigna members, visit Cigna for Health Care Professionals > Resources > Behavioral Resources > Doing Business with Cigna > Authorization and Billing Resource.

Exception 2: Home health, infusion, labs and dialysis

Either Cigna or Priority Health’s network can be used for these services. Providers can be found on either Cigna’s Provider Directory or Priority Health’s Find a Doctor tool. If required, prior authorizations may be requested through the appropriate network. If there is a duplicate national contract for these services, then Cigna’s network will supersede. Example: national lab LabCorp has a contract with Cigna and Priority Health, so therefore Cigna would reimburse the claim. Cigna members can choose whichever lab they want to, but the provider payment would be dictated by who has the national contract.

Cigna for Health Care Professionals: To use this tool, you must be a registered user with precertification access. Once logged in, you will be able to look up precertification requirements under Useful Links > Precertification Policies.

CHCP - Resources - Precertification: Click on the Complete List of Services to see which require precertification. This webpage also has a link to frequently asked questions related to precertification.

Visit eviCore or call eviCore at 888.693.3297.

For Priority Health members, continue to use the Auth Request tool to request high-tech radiology authorizations through eviCore.

Cigna uses Accredo for all of its member’s specialty pharmacy services. Accredo will ship specialty medication to the member’s home or the location of their choice. Information for prescribers can be found at accredo.com/prescribers.

Cigna’s Specialty Care Options^SM (SCO) and Cigna Specialty Care Options Plus^SM (SCO+) programs identify members whose specialty medications are being administered in a higher-intensity setting (e.g., outpatient hospital) to determine whether a less-intensive site of care is clinically appropriate. When clinically appropriate, Cigna redirects customers to a quality, less-intensive site of care, such as a contracted provider’s office, a member’s home with infusion nurses, or a non-hospital-based ambulatory infusion center. 

To access the SCO and SCO+ drug list, log in to the Cigna for Health Care Professionals website (CignaforHCP.com) > Resources > Reimbursement and Payment Policies > Precertification Policies > Specialty Care Options and Specialty Care Options Plus Drug List. Specialty medical injectables may be added upon U.S. Food and Drug Administration approval.

There’s no change for your existing Priority Health patients. For Cigna Open Access Plus® (OAP) members, Priority Health contractual terms and reimbursement apply, with a few exceptions in ancillary care. For Cigna members getting ancillary services like durable medical equipment, behavioral health home infusion, and vision Cigna's national ancillary agreements and reimbursement will apply.

To see our fee schedules, log in to your account.

Cigna will verify claims matches the provider information received by Priority Health. Claims need to match billing name, address, tax id, and NPI. If the information does not match, the claim will price out-of-network.

If an ancillary service is not provided by the required provider based on the member’s plan, it could price out-of-network.

Yes, Priority Health commercial group members that get care outside of Michigan have access to the Cigna Open Access Plus (OAP) network. OAP in-network providers can be found on Cigna’s provider directory.

No, only commercial group members.

Claims for Priority Health members should always be submitted to Priority Health, not Cigna. Simply follow any instructions on the member ID card for submitting claims, prior authorizations or calling for assistance. More information on billing and authorizations for providers outside of Michigan can be found on our site.