Priority Health (Michigan) Letter of Medical Necessity Guide
How to write an LMN and overturn a prior authorization denial with Priority Health (Michigan). Includes denial reasons, turnaround times, appeals address, and clinician tips.
Quick Facts
- Avg Turnaround: 30 days standard, 72h expedited
- Appeals Address: Priority Health Appeals, PO Box 232, Grand Rapids, MI 49501
- Provider Portal: https://www.priorityhealth.com/provider
Why Priority Health Denies Prior Authorizations
- 1. Medical policy criteria not met
- 2. Step therapy
- 3. Non-formulary
- 4. Quantity limit
- 5. Specialty pharmacy required
Clinician Tips for Priority Health
- ✓ Priority Health is the Michigan-based insurer owned by Spectrum Health/Corewell Health system
- ✓ Reference Priority Health Medical Policy number in LMNs
- ✓ MedTrak is the pharmacy benefits administrator; submit PA via the Priority Health provider portal or CoverMyMeds
- ✓ Priority Health also offers Medicare Advantage and Medicaid plans — timelines differ by line of business
Michigan-based provider-sponsored plan (Corewell Health/Spectrum Health). Second-largest commercial insurer in Michigan. MedTrak PBM. Medical Policies are searchable on priorityhealth.com.
Priority Health Prior Authorization FAQ
Why does Priority Health deny prior authorizations?
The most common Priority Health denial reasons are: Medical policy criteria not met; Step therapy; Non-formulary; Quantity limit; Specialty pharmacy required.
How long does Priority Health take to review a prior authorization?
Priority Health typically responds in 30 days standard, 72h expedited.
What should a Letter of Medical Necessity for Priority Health include?
An LMN for Priority Health (Michigan) should reference the specific medical policy or coverage bulletin, document failed first-line therapies with dates, include current labs and ICD-10 codes, and cite supporting clinical guidelines. Michigan-based provider-sponsored plan (Corewell Health/Spectrum Health). Second-largest commercial insurer in Michigan. MedTrak PBM. Medical Policies are searchable on priorityhealth.com.