Total Health Care (THC) integration information

Updated Jan. 1, 2022

Welcome to Priority Health! We’re thrilled to have you in our network. Together, we’ll help keep health care affordable and accessible for our members by maintaining long-term sustainability while delivering viable solutions in southeast Michigan.

As of Jan. 1, 2022, all THC plans have officially transferred to Priority Heath, including Medicaid, group and individual plans.

As a Priority Health provider, you now have access to:

  • Tools and platforms – We upgraded the tools we use to support our provider network in 2021. You'll benefit from these enhancements, which will allow you to quickly update provider information changes in our Provider Roster Application (PRA), easily identifying gaps in care through our patient registry and better understand your performance in key quality measures using Filemart.
  • Online and webinar communications – You'll have access to our digital content and education, including our Virtual Office Advisory webinars and much more.
  • PCP Incentive Program (PIP) –accountable care network (ACN) participating providers can earn incentive dollars for meeting key quality thresholds through our PIP program.
  • Patient panel growth – You'll transition to a participating provider for our members, including Medicare Advantage.
  • Specialty provider network – You'll experience greater accessibility to specialists for Medicaid patients through our specialty and ancillary provider network. 

How to best work with us

Question Answer
How do I know if my patient is participating with Priority Health?
Your patient will have a Priority Health ID card.
What is the network and governing contract for reimbursement?
Priority Health contractual terms and reimbursement apply.
How do I confirm eligibility or benefits for my patients?
  • Log into your provider prism account and find the Member Inquiry tab
  • Within Michigan: 800.942.4765
  • Outside of Michigan: 833.300.3628
  • Electronic data interchange (EDI) clearinghouse
How do I submit claims?

Electronic: Use Priority Health payer ID 38217
Paper:
Priority Health Claims
P.O. Box 232
Grand Rapids, MI 49501

How does Priority Health process claims?

Detailed list of claim filing limits

How can I review claim status?
How do I submit an appeal?

Log into your provider prism account and and then find the Appeals tab
Who do I contact for prior authorization or medical management services?
  • See the patient's ID card for instructions
  • Online
  • We've developed this chart to help you manage different authorization scenarios for members who've recently transferred from THC
How do I request prior authorizations for high-tech radiology?
 Click Request an Authorization on our Authorizations webpage