Information for providers outside of Michigan seeing a Priority Health member

Priority Health is a strategic alliance partner of Cigna. This means that participating Priority Health plan members get in-network benefits with any Cigna Open Access Plus (OAP) provider, anywhere in the U.S., outside of Michigan. These members have access to Cigna’s quality health care network that features nearly one million health care providers nationwide.

Members with Cigna OAP network coverage will have the Cigna logo on their member ID card. Check both the front and the back of the card; members who live in Michigan only have the Cigna logo on the back. 

Learn more about our Cigna alliance here.

Eligibility and prior authorization for HMO members

Priority Health HMO plan members need a prior authorization before receiving non-emergent care outside of Michigan. To request a prior authorization, or to find other eligibility and benefit information about a Priority Health member, providers should call the Priority Health out-of-state helpline at 833.300.3628.

See the front of the member ID card for plan type information in the “Health plan” field.

Billing

Always submit claims for Priority Health members to Priority Health, even when Priority Health members are accessing care through the Cigna OAP network. Use the instructions below for submitting claims and prior authorizations, or follow the instructions on the member’s ID card. 

Electronic claims submission:
Use Priority Health payer ID 38217

Submit paper medical claims:
Priority Health Claims
P.O. Box 232
Grand Rapids, MI 49501

Reminder: Make sure your remittance address is correct on your claims. This will help us ensure timely payment. To update the remittance address we have on file, you can submit an update through our provider portal, prism, or call our Provider Helpline at 800.942.4765 for assistance.

Authorizations

We require prior authorization for certain services and procedures. In these cases, providers will submit clinical documentation and medical records demonstrating that the service or procedure is medically necessary.

How to request an authorization

Use the forms below to request prior authorization for medical services. Always use a specific service form when available. Turnaround times vary by plan requirements, but all cases are 14 days or less.

Cardiac & MSK services managed by TurningPoint

Effective Aug. 20, 2024, TurningPoint manages certain cardiac and MSK procedures and services on behalf of our members.

See a list of codes managed by TurningPoint. If requesting a procedure or service managed by TurningPoint, use the following form:

• TurningPoint prior authorization form

All other procedures / services

Outpatient, elective/planned inpatient admissions

• Medical prior authorization form
  Before using this form, review the prior authorization forms below to determine whether there’s a specific service form available for your request.
• Clinical trials prior authorization form
• DME/P&O prior authorization form

Hospital and other facility

• Acute Rehab/LTACH/SNF/SAR prior authorization/review form
  Use this form for all post-acute facility requests. Note: We’ve updated this form. Effective May 22, 2022, we will only accept this new form. Old forms will be returned via fax as they don’t have all the necessary information.
• Bone marrow/peripheral stem cell or other blood cell transplant prior authorization form
• Emergent inpatient prior authorization form
  A request is considered emergent if delaying treatment would put the patient’s life in serious danger, interfere with full recovery or delay treatment for severe pain. Don’t use this form for elective/planned inpatient admissions, instead use the Medical Prior Authorization Form. If we determine your request doesn’t meet the definition of an emergent authorization, it will be processed according to standard timelines. All emergent cases are reviewed in 72 hours or less.
• NICU/sick newborn prior authorization form
• Solid organ transplant prior authorization form

Behavioral health

• Applied Behavioral Health (ABA) therapy prior authorization form
• Behavioral health prior authorization form
  Use this form for psychiatric inpatient, outpatient psychotherapy (mental health and substance abuse), detoxification, residential treatment and other behavioral health services.
• Transcranial Magnetic Stimulation (TMS) for depression prior authorization form

Home health care services

• Home health care services prior authorization form
• Home health care IV infusion services prior authorization form

How to check your authorization status

1. Log into your prism account
2. Open the Authorizations menu
3. Click Check Auth Status

Don't have a prism account? Contact our Provider Helpline for help checking the status of your authorization request.

Referrals

Refer to other providers in Cigna's OAP network so that Priority Health members can keep their care in-network while living, working or traveling outside of Michigan. Use the button below to find Cigna OAP providers.

Cigna OAP provider search

Still have questions?

If you need further support, or if you want to determine authorization requirements or check the status of an authorization request over the phone, call our out-of-state provider helpline at 833.300.3628.