PLANS AND BENEFITS
New resources available for the HMA product, launching January 1
As previously announced, our new third-party administrator (TPA) product, HMA, is taking effect on January 1 for the employer groups and their members who have purchased it. To make sure you’re as prepared as possible, we’ve created an HMA page in our provider manual. This page includes:
- Sample member ID card images
- Guidance on working with members: eligibility, prior authorization, claims, appeals, support
- Information on the HMA provider portal
- A breakdown of HMA tools and when to use them
- Information for providers outside of Michigan
- FAQs
- Additional resources, including a short video
PRIORITY HEALTH
Reminder: Credentialing and enrollment status updates are available in prism
If you need an update on the status of your credentialing or enrollment request, you can easily find it in prism.
There are two ways:
- In prism, click Enrollments & Changes. You’ll find a list of enrollment / change requests with columns for date submitted, current stage of the process and status.
- Under Enrollments & Changes, click on the Inquiry ID for the enrollment / change in question. There’s a status bar showing what part of the process you’re in (contracting, credentialing, enrollment, reimbursement or complete), as well as any comments. Don’t add a new comment requesting a status update. Our system automatically pushes inquiries with new comments to the bottom of the queue, and this will delay your request.
When your enrollment request is complete, you’ll receive a comment on your inquiry in prism, as well as a notification via email alerting you to the comment, that will include your effective date. Please remember:
- Our timeframe for processing new enrollments is 80 days.
- Each step in the enrollment process has a unique timeframe that falls within the 80 days. Credentialing is the most time consuming, so you may see your inquiries in this stage for most of the process. This is normal.
For more information, our credentialing webpage shows step-by-step instructions and more information on how to check the status of a request, timelines and more. If your request has exceeded 80 days, email exceedsprocessingtime@priorityhealth.com.
Reminder: the best way for practices to communicate with us is through prism
The best way for practices to communicate with us about questions and requests is through prism accounts – not email.
By communicating through prism, we’re better able to:
- Route requests to the appropriate team for faster response or resolution
- Connect the inquiry to a specific claim, enrollment request, etc.
- Track the history of the correspondence
Our Get Your Questions Answered document outlines how to submit questions through prism and route them to the appropriate Priority Health team. We encourage you to bookmark the URL for quick access to the most up-to-date version.
Visit our prism resources webpage for information on how to sign up for a prism account, a helpful video on when and how to reach out to us via prism, step-by-step instructions for common needs, and more.