Αποτελέσματα Αναζήτησης
Click on Enrollments & Changes and select the appropriate enrollment type. Learn more about how to complete the application. If you're a behavioral health provider, see our behavioral health provider participation instructions. Complete all fields and click Submit.
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.
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.
Enrollment form instructions. Employees. Thank you for choosing Priority Health. Please complete this form for yourself and any dependents you wish to cover. A few reminders to help you complete this form: Please print clearly using blue or black ink.
Through our Provider Roster Application (PRA) tool, you can actively manage your primary care providers’ information simply and effectively for their participation in our value-based programs. This includes our PCP Incentive Program (PIP), Disease Burden Management program (DBM) and, if you participate, our Alternative Payment Model (APM).
23 Αυγ 2021 · Note: Please include the date the online enrollment was completed on the Optum360 ERA Setup Form • Email the PDF forms to Optum.ERA@officeally.com • Standard processing time is 14 business days
Enrollment form checklist: 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
