Fee Schedules Effective Jan. 1, 2026 are now available online for all commercial plans (login required).

Each year, we review and update our commercial fee schedules. We evaluate national and regional data to develop fee schedules that balance the needs of providers with those of employers and members, ensuring we’re providing excellent and affordable health care to the communities we serve.

Access Priority Health Medicaid Provider Manual

In addition to our digital Provider Manual, we also have a separate Medicaid Provider Manual in PDF form. You can access it online here. 

Need a hard copy? 

We can send you a hard copy of the Medicaid Provider Manual on request. To obtain a copy, contact our Provider Helpline at 800.942.4765. 

The Medicaid Provider Manual is updated annually, whereas the digital Provider Manual is updated throughout the year as changes occur. 

Need the State’s Medicaid Provider Manual? 

The Medicaid Provider Manual from the Michigan Department of Health and Human Services (MDHHS) can be found here.  

PIP Reports Delivered Weekly

To help you address open gaps in care and maximize PIP / HEDIS scores as we approach the end of the 2025 performance year, ACNs will soon begin receiving the following reports in Filemart weekly:

• PIP Hypertension Worksheet (PIP_11H): ACN level report. Reflects blood pressure dates and result values, if applicable. Includes Type II NPI, PRA Group, PRA Subgroup.
• PIP Diabetes Lab Result Worksheet (PIP_11G): ACN level report. Reflects diabetes dates and result values, if applicable. Includes Type II NPI, PRA Group, PRA Subgroup.

 ACNs will receive the first of these weekly reports in early December, and reports will continue to be sent through January 2026.

Steqeyma and Starjemza Added to Coverage

With the growing use of Stelara® biosimilars, we’re expanding coverage to include additional options for our commercial group and individual members to ensure they have access to needed treatment. 

Effective immediately, Steqeyma® and Starjemza™ are covered under the pharmacy benefit at Tier 4 with prior authorization requirements and under the medical drug benefit, with prior authorization and site of service requirements. 

In addition to Steqeyma and Starjemza, we offer the same coverage for Selarsdi® and Yesintek®, all of which are biosimilars of Stelara and have been granted interchangeable status* by the Food and Drug Administration (FDA). *Rules for interchangeable status vary by state. If your patient is filling their prescription at a pharmacy outside of Michigan, a new prescription for any of the above biosimilars may be required. 

What do they treat?

Steqeyma and Starjemza are interchangeable Stelara biosimilars used to treat a variety of autoimmune conditions, including certain types of plaque psoriasis, active psoriatic arthritis, Crohn’s disease, and ulcerative colitis.