What types of policy changes does Priority Health issue?

Priority Health regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Priority Health update its policies?

Priority Health typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Priority Health policy changes are tracked here?

This page currently tracks 14 documented Priority Health policy changes. New items are added as they are identified.

What should I do when Priority Health changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Priority Health Policy Changes & Prior Auth Updates

We track 14 documented policy changes from Priority Health across MI. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Priority Health notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Priority Health updates automatically.

High impact
Notice of Admission requirement delayed until Sept. 1
Priority Health·Effective Sep 1, 2026
Priority Health is implementing a Notice of Admission (NOA) requirement for all hospital inpatient admissions starting September 1, 2026. Facilities must notify Priority Health within 24 hours of any inpatient admission through automated ADT sharing or manual portal submission.
Medium impact
2026 PIP reports to be sent via SFTP from Sept.-Dec.
Priority Health·Effective Sep 1, 2026
Priority Health is transitioning 2026 PCP Incentive Program (PIP) reports for HEDIS and Transformation of Care measures from Filemart to SFTP delivery starting September 2026. Medicare Part D measure reports will continue via secure email through the end of the program year.
High impact
May medical policy updates
Priority Health·Effective Jun 1, 2026
Priority Health is implementing extensive medical policy updates effective June 1, 2026, affecting multiple specialties including retirement of apnea monitor and bronchial thermoplasty policies, expanded coverage for balloon sinus procedures, new prior authorization requirements for certain surgeries, and changes to durable medical equipment coverage including making CPM devices no longer covered.
High impact
Update to inpatient readmission review & appeal processes
Priority Health·Effective Mar 1, 2026
Medicare plans will now review inpatient readmissions after claim submission rather than during prior authorization. Billing teams may receive authorization approval but later see claim denials due to readmission rules, with different dispute processes depending on when the denial occurs.
High impact
Reminder: New payment & RA processes coming Sept. 1
Priority Health·Effective Sep 1, 2026
Starting September 1, 2026, Priority Health will transition payment processing from their legacy system to ECHO Health Inc. in partnership with Optum Financial. Providers currently receiving EFT/ERA payments will be automatically migrated, while providers receiving paper checks must set up new payment preferences during the July 1-September 1 enrollment window.
High impact
medical documentation required for billing above MUE limits
Priority Health·Identified Jun 16, 2026
Priority Health now requires specific medical documentation when billing above Medically Unlikely Edit (MUE) limits. Claims exceeding MUE limits without proper documentation explaining medical necessity will be reduced or denied, even when care is clinically appropriate.
Medium impact
Drug dosing modifier (JW/JZ) edit denying in error
Priority Health·Identified Jun 16, 2026
Priority Health's system is incorrectly denying drug dosing claims with error code U83 even when providers correctly follow billing guidance by not using JW/JZ modifiers on line 1. The insurance company will automatically reprocess all impacted claims once their system is fixed, requiring no action from providers.
High impact
New Provider Portal coming September 1; registration begins as early as June
Priority Health·Effective Sep 1, 2024
Priority Health is replacing their current prism provider portal with a new Epic-based Provider Portal on September 1, 2024. Site administrators must register beginning June 15, and all other users must register starting August 3 to ensure uninterrupted access.
Medium impact
Register now for our new Provider Portal site creation training beginning June 8
Priority Health·Effective Sep 1, 2024
Priority Health is launching a new Provider Portal on September 1 and requires all practices to create a site beforehand. Site Administrators (currently called prism Security Administrators) must attend training starting June 8 to learn the site creation process, which opens June 15.
Low impact
Get our spring Quarterly Newsletter and Quality Newsletter
Priority Health·Identified Jun 16, 2026
Priority Health has released their spring 2026 Quarterly Newsletter and Quality Newsletter containing latest news, updates, and information to help providers work with the payer and provide better member care. The newsletters are distributed to ACN contacts and providers with prism accounts who opted in to communications.
Medium impact
Reminder: Medicare providers are required to see our dual eligible members regardless of Medicaid status
Priority Health·Identified Jun 16, 2026
Medicare network providers are required to see all dual-eligible members (D-SNP and Dual Premier plans) even if the provider is not in the Medicaid network. This applies when these members have Medicaid as secondary coverage since dual-eligible plans are considered Medicare plans.
Low impact
Announcing our 2026 Provider Mini‑Grant recipients
Priority Health·Identified Jun 16, 2026
Priority Health announced the 2026 Provider Mini-Grant recipients, funding three projects focused on improving diabetic eye exams, asthma diagnosis, and quality measure reporting through new technologies and AI tools.
Medium impact
New CMS program expands Medicare access to GLP-1 weight loss medications starting July 1
Priority Health·Effective Jul 1, 2026
CMS is launching the Medicare GLP-1 BRIDGE Program on July 1, 2026, providing Medicare beneficiaries access to weight loss GLP-1 medications (Wegovy, Foundayo, Zepbound) with a $50 copay per fill. This program operates outside Medicare Part D plans and is managed by Humana as the central processor for prior authorization and claims processing.
Medium impact
prism Security Administrators: Create a site for our new Provider Portal beginning Monday, June 15
Priority Health·Effective Jun 15, 2024
Priority Health is launching a new Provider Portal to replace the existing prism system. Current prism Security Administrators must create sites starting June 15, 2024, to ensure access when the portal launches September 1, 2024.

Priority Health in MI Priority Health: Allergy & Immunology Priority Health: Cardiology Priority Health: Endocrinology Priority Health: ENT (Ear, Nose & Throat)All payers

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Notice of Admission requirement delayed until Sept. 1

2026 PIP reports to be sent via SFTP from Sept.-Dec.

May medical policy updates

Update to inpatient readmission review & appeal processes

Reminder: New payment & RA processes coming Sept. 1

medical documentation required for billing above MUE limits

Drug dosing modifier (JW/JZ) edit denying in error

New Provider Portal coming September 1; registration begins as early as June

Register now for our new Provider Portal site creation training beginning June 8

Get our spring Quarterly Newsletter and Quality Newsletter

Reminder: Medicare providers are required to see our dual eligible members regardless of Medicaid status

Announcing our 2026 Provider Mini‑Grant recipients

New CMS program expands Medicare access to GLP-1 weight loss medications starting July 1

prism Security Administrators: Create a site for our new Provider Portal beginning Monday, June 15