Contact provider services
Provider Helpline
Mon.-Thurs. 7:30-5; Fri. 9-5
Press:
1 – Claims, benefits, eligibility
2 – Pharmacy
3 – Authorizations, health management status
4 – Behavioral Health
5 – Password help
6 – Connect to 5-digit staff extension
7 – Contracting, credentialing
Get your questions answered
Use our Get your questions answered help guide to direct all of your claims, credentialing, enrollment and general portal questions. Using the proper channels will help you to hear from us quickly.
Get your questions answered guide
Appeals contacts
Log into your prism account and click Appeals. There you'll be able to initiate authorization and claim appeals by sending a secure message to our team, as well as see the status of your requests.
For instructions and forms, check our Appeals page.
Authorizations, authorization status contacts
800.942.4765, option 3
Mon.-Thurs. 7:30-5; Fri. 9-5
Urgent after-hours authorizations only
Call 800.269.1260. Leave a phone number and message. A nurse care manager will return your call within 30 minutes.
Auth status
Log into your prism account and click Authorizations, then Auth Inquiry to see the status of your authorizations.
Fax 616.942.0024
Priority Health Authorizations
MS 1255
1231 East Beltline NE
Grand Rapids, MI 49525
Behavioral health contacts
Emergency treatment for behavioral health conditions doesn't require prior authorization.
Non-emergency inpatient authorization requests, fax to: 616.975.0249
A clinician will contact you during regular business hours.
Mon.-Fri. 8-5
Claims contacts
For fastest service: Request a Priority Health provider account, then log in to use our Claims Inquiry tool.
Submitting claims
- How to bill Priority Health
- Claim deadlines
- Correcting claims
- Balance billing
- Set up electronic claims/Remittance Advice file exchange
- Set up electronic funds transfer
- Request a claim review
- Appeal a denied claim
Status a claim
Log into your prism account and select the appropriate option under the Claims menu to see the status of your claims.
No DCN number?
Log into your prism account and within the Claims section, review front-end rejected claims. If you don't see your claim, go to General Requests, click New Request and choose the option "Claim not found > 60 days."
Contracting
Priority Health Contracting
MS 2320
1231 East Beltline NE
Grand Rapids, MI 49525
Log into your prism account and click General Requests. There you can submit general contracting questions for review. You can also see the status of your requests by clicking the Inquiry ID.
Credentialing, enrollment
Log into your prism account and click Enrollments & Requests. There you can submit new individual and organization enrollment requests and change requests. You can also see the status of your requests by clicking the Inquiry ID.Priority Health Provider Enrollment & Life Cycle
MS 2320
1231 East Beltline NE
Grand Rapids, MI 49525
Drug authorizations, formulary exceptions
Mon.-Thurs. 7:30-7; Fri. 8-7; Sat. 8:30-Noon
Pharmacy Help Desk
Fax 616.942.8206
Electronic data, file exchange info & setup
Create a prism account
Get access to our online member eligibility, authorizations and claims tools.
Submitting electronic claims
How to set up HIPAA-compliant electronic (EDI) claim files.
Mailing paper claims
Priority Health Claims
P.O. Box 232
Grand Rapids, MI 49501
Out-of-network Provider Guide
- Authorizations
- Billing & payment
- Procedures & services
- Reviews & appeals
- Drugs
- Medical policies
- Provider forms
- Seeing Cigna members
- Requirements & responsibilities
- Clinical resources
- News
- Fraud, waste & abuse policy
- Join our networks
- Check patient eligibility
- Data exchange
- Set up electronic claims
- Set up electronic funds transfer (EFT)
- Check claim status