Complete Story
05/20/2025
Priority Health Update
Priority Health Managed Care Committee Member
Flora Werle - The Cancer & Hematology Centers
Click here to visit the Priority Health Provider News Page for additional updates.
New Virtual Digestive Health Support Platform Available June 1 for all Priority Health Commercial Members
Beginning June 1, all commercial (group and individual) Priority Health members will have access to a virtual gastrointestinal (GI) health platform through Ayble Health®. Ayble provides GI-specialized nutrition guidance, behavioral skills training, health coaching and additional care team support to a wide range of digestive health patients.
Ayble’s providers work hand in hand with local clinicians to provide wraparound support at home in between appointments. Ayble also includes powerful tech tools, including on-demand 24/7 access to GI-specialized behavioral health resources, GI nutrition guidance, a powerful groceries database to make easy choices at the store, a symptom and health tracker and educational resources.
Food Delivery Services Covered for Some Medicaid Members Starting June 1
Beginning June 1, some Priority Health Medicaid members will be covered for food delivery services under the Michigan Department of Health & Human Services (MDHHS) in lieu of services (ILOS) initiative. The goal for ILOS is to improve health and reduce the future need for medical services by addressing food insecurity and ensuring members have access to nutritious foods.
Partnering With Arine to Support Adherence for Disengaged Priority Health PPO Members
We’re partnering with Arine, our Medication Therapy Management (MTM) vendor, to support medication adherence for Priority Health PPO members who are noncompliant or tracking toward noncompliance with their medication.
Arine’s outreach is fully funded by Priority Health and won’t impact the administrative budgets of ACNs participating in an Alternative Payment Model (APM) contract.
What’s happening?
Beginning now through December 2025, Arine’s contacting Priority Health PPO members with medication adherence care gaps to help with the following:
- Educate members on the health benefits of staying consistent with medication
- Offer tips and clinical best practices for taking their medication
- Identify barriers to adherence and find resources available through the member’s plan to help with affordability or accessibility
- Assist the member with accessing the programs and resources available to them
- Encourage members to see their PCP for needed care
Commercial and Medicaid Formulary Changes Taking Effect
Commercial formulary changes take effect July 1
Each July, the Priority Health Pharmacy and Therapeutics committee makes changes to the commercial group and individual formulary to align with industry and regulatory changes and to ensure our members have access to safe and effective drugs. Beginning Jul. 1, 2025, changes will be implemented that will either add or remove a drug from the formulary, change the tier a drug is in or change the prior authorization or step therapy requirements of a drug. Site of Service changes and changes to the SaveOnSP drug list are also included.
TurningPoint Portal will be Offline Briefly for Maintenance on May 24
Due to scheduled maintenance, on May 24, 2025, the TurningPoint authorizations portal will be unavailable to submit authorization requests for a period of 45 minutes between 7-9 p.m. ET.
You may wait to submit your authorization requests until the portal is back online, or you may choose to submit via phone or fax.
- Phone: Call 313-221-5553 or 855-511-0840 (toll free)
- Fax: Submit TurningPoint’s authorization intake form to 313-261-7199 or 833-374-0036 (toll free)
May 2025 Billing Policy Updates
We publish billing policies to offer transparency and help providers bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.
The following billing policies were recently published to or updated in our Provider Manual.
May 2025 Medical Policy Updates
Our Medical Affairs Committee (MAC), comprised of Priority Health network physicians, met in May and approved the following medical policy updates. Unless otherwise noted, the updates are effective June 1, 2025.
Update to 2025 PIP Supplemental Data Submission Deadline
To support quicker, more efficient processing of supplemental data for the 2025 PCP Incentive Program (PIP), we’ve established two submission deadlines:
- Nov. 1, 2025: Dates of service between Jan. 1-June 30, 2025
- Jan. 31, 2026: Dates of service between July 1-Dec. 31, 2025
This new process is in alignment with industry trends in supplemental data submission and will allow the services you provide our members in the first half of the year to be reflected in your PIP reports sooner – giving more time to identify why a gap may not have been closed with the supplemental data provided.
Note: You may still submit blood pressure and A1c results at any time of year, regardless of date of service.
The 2025 PIP manual (login required) has been updated to reflect this change.
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