Priority Health
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.