Responsibilities and standards news
9/2/2025: Reminder: You must complete our D-SNP Model of Care training by Dec. 31
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see PriorityMedicare patients are trained on our Model of Care (MOC) every year.
September 2, 2025
New Provider Education Module: Updating your Find a Doc information in prism
How to update FAD provider information in prism
August 20, 2025
August 2025 medical policy updates
Our Medical Affairs Committee (MAC), comprised of Priority Health network physicians, met in August and approved the following medical policy updates. Unless otherwise noted, the changes will go into effect on Sept. 1, 2025.
August 18, 2025
Change to ACN enrollment rules
Effective July 8, 2024, we’ll no longer allow providers to be enrolled under more than one ACN contract at a time under the same NPI, TIN and address. This includes ACNs with both direct and delegated contracts.
August 13, 2025
Annova: New vendor supporting medical record retrieval
New vendor supporting medical record retrieval for risk adjustment.
August 6, 2025
07/15/2025: prism login reminder
Make sure you’re logging into prism frequently. After 120 days without a login, your account will be considered inactive, and you’ll temporarily lose access.
July 15, 2025
Medicaid audit underway
The state is sending providers requests for Priority Health Medicaid patients' medical records.
July 9, 2025
Technical denials no longer apply to in-network providers' claims
We’re no longer applying technical denials to in-network provider claims.
July 7, 2025
IMRT to be added to post-pay audit program effective Aug. 23
Effective Aug. 23, 2025, intensity modulated radiation therapy (IMRT) will be added to the scope of our Post Payment Complex/Clinical Audit (PPCCA) program, supported by our vendor, Performant Recovery, Inc. (Performant).
July 7, 2025
You must complete our DSNP MOC training
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see PriorityMedicare patients are trained on our Model of Care.
June 30, 2025
Reminder to complete our D-SNP Model of Care training
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see PriorityMedicare patients are trained on our Model of Care.
June 30, 2025