Seeing a Priority Health or Cigna member in Michigan

Question Priority Health member Cigna member
How do I know if my patient has Priority Health or Cigna as the primary plan administrator? Your patient will have a Priority Health ID card.
  • Your patient will have a Cigna Open Access Plus® (OAP) ID card. Their card may display the Cigna logo and the name of the Strategic Alliance their plan is affiliated to.
  • Learn more about the Cigna Strategic Alliances. 
  • Any health plans with access to Cigna Open Access Plus® (OAP) Network can use the Priority Health PPO network.
What is the network and governing contract for reimbursement?
  • Providers in Michigan: 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 and home infusion, Cigna's national ancillary agreements will apply. See FAQs below for more information about ancillary care.
  • Providers outside Michigan: Cigna's contractual terms and reimbursement apply in all other states.
How do I confirm eligibility or benefits for my patients?

How do I submit claims?

See FAQs for exceptions related to ancillary care
  • Electronic: Use Priority Health payer ID 38217
  • Paper: Priority Health Claims
    P.O. Box 232
    Grand Rapids, MI 49501
  • Online
  • Electronic: Use Cigna payer ID 62308
  • Paper: Use the address on back of ID card

Who processes claims and issues the explanation of payment, explanation of benefits, or statement of account?

See FAQs for exceptions related to ancillary care

 Priority Health Cigna, a Cigna TPA partner or a Cigna Strategic Alliance partner
How can I review claim status?

See the back of the patient's ID card.

Cigna Customer Service: 800.882.4462
Who do I contact if I have issues with payment from Cigna?
    

Call Cigna Provider Services line: 800.882.4462

Haven’t received payment? Cigna will need your claim number, patient name and date of birth, date of service and Member ID number

Remittance amount doesn’t match fee schedule? Call the number above or complete Cigna’s online appeal form.

See Reimbursement FAQs for common claim questions.
How do I submit an appeal? See the Provider Manual for information on claims and authorization appeals by plan type.

Through the mail:
Attn: Cigna Appeals Unit
PO Box 188011
Chattanooga, TN 37422

If the Cigna ID card indicates GWH-Cigna or 'G' on the front of the card:

Attn: Cigna Appeals Unit
PO Box 188062
Chattanooga, TN 37422-8062
Who do I contact for prior authorization or for medical management services?
  • See the patient's ID card for instructions
  • Online
How do I request prior authorizations for high-tech radiology?

In Michigan: Login to your provider account and Request an Authorization

Outside Michigan: Use our provider manual
Who do I contact if I have a question on a Behavioral Health claim for a Cigna member?   Behavioral Health providers are excluded from the Alliance. Services are provided through Evernorth Health Services. Contact Cigna’s provider service line at 800.433.5768 to review the status of the claim.