Update: New Provider Portal and Payment Vendor Launch Delayed
The launch of our new Provider Portal has been delayed to January 1, 2027. We’re making this change to give providers more time and support for a smooth transition. READ MORE
Updated Timelines for Our Payment Process Change
We recently announced that we postponed the payment process updates with ECHO Health Inc. (“ECHO”) until Jan. 1, 2027, to align with the new launch date of our Provider Portal powered by Epic.
For dates of service through Dec. 31, 2026, your Priority Health payments and remittance advices will continue to be delivered as they are today, with delivery via ECHO beginning with 2027 dates of service. Any enrollments or updates you made with ECHO that differ from your current setup with Priority Health will not take effect until Jan. 1, 2027. READ MORE
September 2026 Billing Policy Updates
We publish billing policies to offer transparency and help you bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information. To view billing policies CLICK HERE
Reminder: Use a Street Address for the Billing Provider Address on Your Claims
Effective Nov. 16, 2026, we’ll no longer accept commercial and Medicare claims submitted with a P.O. Box in the Billing Provider address field. These claims will be front-end rejected back to the provider. This already applies to Medicaid claims and is in alignment with HIPAA standard and NUCC guidance. READ MORE
Retrospective Authorizations Limited Effective Nov. 1
Effective Nov. 1, 2026, prior authorization must be obtained before services are rendered for all services that require authorization. Retrospective authorization requests – requests submitted after services have already been provided – will only be considered in limited, exception-based situations.
This change impacts all plans (Medicare, Medicaid and commercial) across medical / surgical services, outpatient services, lab tests and drug authorizations. (Note: This change doesn't apply to behavioral health or durable medical equipment (DME) authorization processes.) READ MORE
ETS Will Be Our Exclusive Vendor for Transplants and Gene and Cell Therapy for Medicare and Medicaid
Effective Oct. 1, 2026, Emerging Therapy Solutions (ETS) will be Priority Health’s exclusive vendor for bone marrow transplants, organ transplants and CAR T-cell and gene therapies. This will be in effect across all lines of business, now including Medicare and Medicaid. READ MORE
Updated 2026 PIP Manual Now Available
We recently made updates to the 2026 PCP Incentive Program (PIP) Manual READ MORE
Check Out Our New Provider Education Videos on Risk Adjustment
We have two new provider education video modules available for you this month:
What are provider education modules?
Provider education modules are short videos from Priority Health experts on single topics, including billing & coding, authorizations, prism, plans & benefits and more.
Check out our modules page here for more content.
Reminder: Access to Care Standards Apply
We’re committed to helping members access care when they need it – 24 hours a day, seven days a week. We expect providers to follow the appointment and timely access to care standards outlined in the Priority Health Plan provider contracts.
Every year, we measure provider performance against these standards. Please familiarize yourself with the standards in our Provider Manual.