Please follow the Enrollment Instructions below to become an electronic submitter for Priority Health.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the Priority Health office prior to initiation of electronic claims submission or inquiry.

1. Electronic Claim Registration Form
2. Electronic Remittance Advice Registration Form


Upon receipt of the forms, Priority Health will then email you two additional applications to complete, the Business Partner Interconnection Questionnaire and the Trading Partner Agreement. If you need any assistance in filling out these additional forms feel free to call the Claimshuttle Support Team for assistance at 602-439-2525.

If you have any questions regarding any of the documents in this package, please call the Priority Health EDI Technology Support Center at 616-464-8686.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Electronic Claim Registration Form

Submitter information

• Please enter your Business or Provider Name

• Enter your TAX ID and NPI

• Please enter your address

Office contact person

• Please enter the name, phone, email and fax for the main contact in your office

Technical information

• This payer sends replies back about your claims by either fax or email. Please select which method you would like to use.

Practice management software vendor

• For Software Vendor enter the following:

  • Please enter the information for the software or vendor that creates your 837 files you need Claimshuttle to transfer for you.

  • If you have paid for our billing software please call our support line for our software information.

• Yes your system can send direct to Priority Health

• Check the boxes for "No" in response to the questions about using a billing service or clearing house

• Sign and Date

Electronic Remittance Advice Registration Form

ERA receiver information

• Enter your Business/Facility Name and Demographic information

• Enter your TAX ID and NPI

• Please enter the name, phone, email and fax of your accounts receivable contact person

Technical information

• For Software Vendor enter the following:

  • Please enter the information for the software or vendor that creates your 837 files you need Claimshuttle to transfer for you.

  • If you have paid for our billing software please call our support line for our software information.

• Answer the following four questions as follows:

• Post ERA files - Yes

• Post withhold and/or capitation - No

• Post Claim Level - Yes

• Post at service line level - Yes

Transmission/Routing of ERA Files

• Please select the following:

  • Receive direct - Yes

  • Method - FTP/PGP Encrypted

  • Skip the rest of this section

HIPAA Compliance

• Select Yes, your System is HIPAA-Compliant

• Select No, your vendor does not send 997 acknowledgments

Registration submitter signature

• Enter your Title, the Date, and Sign the application

ERA test sign-off

• Circle “Will Not” send functional acknowledgement upon ERA file receipt.

• Enter your Title, the Date, and Sign the application

Business Partner Interconnection Questionnaire

Section 1:
 

• Please enter the information for your contact at Priority Health

• Please enter your contact information

Section 2:
 

• Please enter the information for the individual authorized to sign their Legal Agreement

    A. PH to Partner
        Pull - You will pull files from PH
    B. Partner to PH
        Push - You will push files to PH

Section 3
 

• Please call us for our IP Address

Section 4

• Please skip this section

Section 5:
 

• Please enter the following:

"Files we send (837s) will be named syyyymmdd-01
(The "-01" will represent file # of the day)"

Section 6:
 

• Please leave the Local Directory boxes blank

Section 7

• Please skip this section

Trading Partner Agreement

Please fill in your information as the Trading Partner on the last page and then send the entire agreement to PH.

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records.
Fax your completed forms to:

edipro@priority-health.com  OR fax 616.942.9932

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. You will be contacted by Priority Health and sent two additional forms to complete. Please call us if you need assistance in filling out these applications.

After processing, a confirmation will be faxed or emailed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 616-464-8686.

Testing

Once you have received your Submitter ID and Password from Priority Health, please call the Claimshuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to Priority Health.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.