Now available: benefit briefs describing 15 member benefits that we offer as extras on our Priority Medicare plans
Our Priority Medicare and D-SNP plans have many extra member benefits to give your patients access to additional services and support. To give you as much information about them as possible and answer any questions you might have, we’ve created 15 benefit briefs, which include:
- Benefit descriptions
- Vendor partner information
- Information on where services related to the benefit may be performed
- Authorization requirements
- Short guides to accessing and using the benefit
- Coverage criteria
Which benefits have briefs available?
- Abridge: a mobile app for recording health conversations
- Assist America: a worldwide travel assistance program
- Best Buy Health: a personal emergency response system
- BrainHQ: a digital mental activity program
- Delta Dental: routine dental coverage
- EyeMed: routine vision coverage
- Mom’s Meals: a meal delivery program
- MultiPlan: a travel pass for health care coverage outside the lower peninsula of Michigan
- OTC, OTC Plus and PriorityFlex: over-the-counter health products, healthy food access and other payment support benefits
- PriorityCare: companion care and other social supports
- SafeRide: non-emergency transportation
- SilverSneakers: a fitness and physical wellness program
- Teladoc Health Mental Health: a mental health and wellness app
- TruHearing: hearing exam and hearing aid benefits
- Wellth: a chronic condition management tool
Should I share these with my patients?
No, these benefit briefs are intended for providers. If your patients come to you with questions about their benefits, they should be directed to priorityhealth.com/medicare/once-you-enroll to find information about their plan, including extra benefits. They can also contact member support through their online member portal or by calling the number on the back of their Priority Health member ID card.
The new version of Cost Estimator is now live
As originally announced in November 2023, the new version of our Cost Estimator tool is now live for both members and providers. As a reminder, the primary change in this updated version is that it includes pricing and cost-sharing information for all covered procedures and services, in response to the “transparency in coverage ” rule from the federal departments of Health and Human Services, Treasury and Labor.
How do I access Cost Estimator?
Providers still access Cost Estimator through prism. However, rather than it being in a separate tab on the Resources menu, it is now accessed through Member Inquiry.
Where can I get questions about this new version of Cost Estimator answered?
We’ve created this FAQ document to answer many of the questions you may have, including questions about:
- Why we made this change
- How Cost Estimator defines “fair price”
- How cost estimates are calculated
- Updated rates and how these factor into the cost estimates
Why should I use Cost Estimator?
The way people shop for health care continues to change. Consumers are looking for cost transparency and want to know what they are paying for, the same as if they were shopping for a new car or appliance. Talking about costs with your patients, using data from Cost Estimator, can allow you to meet them where they are and help them get the care they need at the right price.
Please encourage your patients to research the cost of their care and have your staff use Cost Estimator when they’re helping a patient with a referral for tests and procedures.
Reminders about seeing Cigna members in Michigan
You may already know that we have a Strategic Partnership with Cigna, through which Cigna commercial group members can access care on Priority Health’s PPO network in Michigan and Priority Health commercial group members can access care on Cigna’s Open Access Plus (OAP) network outside of Michigan.
We want to remind you about some of the specifics of seeing Cigna members in Michigan.
Is there a page in the provider manual with instructions for seeing Cigna members in Michigan?
Yes. It has information about:
- Confirming patient eligibility
- Submitting claims
- Receiving payment
- Reviewing claims status
- Submitting appeals
- Obtaining prior authorizations
- Providing behavioral health care
What about ancillary care?
Check out the ancillary care content drawer on our provider FAQs page to learn about:
- Specialty pharmacy services
Can Cigna’s other Strategic Partners receive care on the Priority Health network, just as Cigna members do?
Yes. These Strategic Partners include:
- TUFTS Health Plan/CareLink
For more information about these Strategic Partners, including sample member cards, see Cigna’s online guide.
As a general rule, simply follow any instructions on the member ID card for submitting claims, prior authorizations or calling for assistance.
2024 VFC program registration open Feb. 1 – Mar. 15
The enrollment portal for MDHHS’s Vaccines For Children (VFC) program will open on Feb. 1. While it typically opens in January, it’s delayed this year due to the Michigan Care Improvement Registry’s (MCIR) server migration.
New and established VFC program providers must complete the enrollment process by March 15 to participate in 2024.
Get more information on VFC and provider enrollment from MDHHS.