Αποτελέσματα Αναζήτησης
If you're a Michigan provider interested in joining our network, see our service area maps and follow the steps outlined below. It can take up to 80 calendar days for us to process your enrollment request.
Enrollees may receive a copy of their Form 1095-B upon request by calling the customer service number on the back of their Member ID card, by logging into their Priority Health member account or by mailing in a request to Priority Health, 1231 East Beltline Ave. NE, Grand Rapids, MI 49525-4501.
Medicare enrollment request form. Choose an enrollment eligibility selection that applies to you on the first page. Check the appropriate box for the plan you wish to join. Choose a primary care provider (PCP), if applicable. To confirm that your doctor, clinic or health center is part of the Priority Health Medicare network of providers, go to
The CMS-855R (Reassignment of Medicare Benefits) form has been discontinued. For additional information regarding the Medicare enrollment process (including Internet-based PECOS) and to get the current version of the CMS-855I, go to CMS.gov/Medicare/Provider-Enrollment-and-Certification.
Clinics, group practices, and other suppliers can apply for enrollment in the Medicare program or make a change in their enrollment information using either: • The Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or • The paper CMS-855B enrollment application. Be sure you are using the most current version.
You may visit our website to learn more about the enrollment process via the Internet-Based Provider • Enrollment Chain and Ownership System (PECOS) at: CMS.gov/Medicare/Provider-Enrollment-and-Certification. All of the CMS-855 applications are located on the CMS webpage: CMS.gov/medicare/cms-forms/cms-forms/cms-forms-list.html
Type 1 NPI – Individual’s Legal Name/SSN. Type 2 NPI – Organization’s Legal Business Name/TIN. Instructions for Completing and Submitting Application. All sections are required, except fields marked “optional”. This form must be typed, it may not be handwritten. Sign and date certification statement. 15B individual provider.
