Priority Health: PriorityActions Issue November 16, 2023

November 20, 2023

We’ve been recognized as a top performer by the National Committee for Quality Assurance (NCQA)

The National Committee for Quality Assurance (NCQA) has given our Medicare HMO/POS plans 4.5 stars (out of 5), making them the top-rated Medicare plans in Michigan and among the highest-rated plans in the nation.

NCQA also recognized our commercial and Medicaid plans:

  • Our Medicare PPO plans received 4 out of 5 stars.
  • Our commercial HMO/POS and PPO were among the top-performing commercial plans in Michigan, with each receiving a 4-star rating (out of 5).
  • Our Medicaid product remained a high-performing plan.

Learn More

Pilot program for at-home colorectal cancer screening for Medicare members launched in October

To help close gaps in care for Medicare members who are due for a preventive colon cancer screening, we’re piloting a program with Exact Sciences to send Cologuard® kits to a small test group of members.

How will I receive my patients’ test results?

Both patients and their attributed PCPs will receive results via mail for each returned kit. Patients who have a positive result will also receive a phone call from the Exact Sciences outreach team.

Can I earn incentives through this pilot?

Your patients who return their test kit to Exact Sciences by Dec. 31, 2023, will count toward your 2023 PCP Incentive Program (PIP) participation.

How does this program differ from Let’s Get Checked?

Our Let’s Get Checked fecal immunochemical test (FIT) campaign, which also screens for colon cancer, takes place annually, while the Exact Sciences’ Cologuard test is recommended every three years. The Exact Sciences pilot program will run in tandem with our Let’s Get Checked FIT campaign and will help us assess member participation in annual testing versus testing every three years.

Your Provider Strategy & Solutions consultant will send you a list of all your patients who received a welcome letter and the Cologuard test via email.

2023 PriorityMedicare D-SNP Model of Care training is due December 31

Who needs to complete the training?

All providers who are part of the Priority Health Medicare Advantage network need to complete training. This includes specialists, ancillary providers, or anyone part of an ICT (interdisciplinary care team) for a D-SNP member. This is a CMS requirement.

How do providers complete the training?

Providers can complete our training using one of two options.

Option #1: Bulk attestations

You can group our D-SNP MOC training with existing, required training (like compliance training) so you can submit attestation for providers at the same time. If this option is selected, you will need to:

  1. Distribute training to your providers using this link.
  2. To attest to training, you must fill out the roster template with providers who’ve received training. If you choose to submit a provider roster, only the Priority Health MOC roster Excel sheet provided will be accepted.
  3. Send attestation rosters to

Option #2: Virtual training (only takes 15 minutes)

Training is available as an on-demand webinar and only takes 15 minutes for providers to complete. Online training can be accessed here. Provider registration for the on-demand webinar counts as attestation, which means no additional documentation is required.

Be sure to submit the correct provider NPI

Ensure the correct provider NPI number is included when submitting the provider roster or registering for the online training. If the NPI is incorrect, the provider’s status will be marked "incomplete" in our system. To correct an "incomplete" status due to an incorrect NPI, resubmit the provider roster or re-register for the online training with the correct provider NPI.

Your Provider Strategy & Solutions consultant will send you a report with providers who still need to complete training via email.