Coverage profile
Work Priority Health across every published route
Use the current payer record to choose the right claim-status, eligibility, portal, phone, or appeals workflow. Substrate only marks routes that are published for this payer.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Priority Health.
Portal claim status
Browser automationThe Substrate Claim Status Agent can check claim status via the payer portal for Priority Health.
Appeals agent
AI appeals workflowThe Substrate Appeals Agent can submit appeals for RFIs, medical record requests, downcoding reconsiderations, and more via the payer portal for Priority Health.
Other aliases
Also known as
- 00493
- 10490
- 38217
- 38217MA
- 7459
- DX021
- PRHTH
- PRIORITY
- PRIRTY
- PRIORTYHTH
- PRIORITY PARTNERS
2027 maternity billing research
When does Priority Health change OB/GYN billing?
Priority Health says patients beginning prenatal care on or after 2026-06-01 are no longer billed with global maternity care codes; bill E/M, required TH, and the correct pregnancy diagnosis. The new code set begins 2027-01-01.
- Transition start
- 2026-06-01
- Billing start
- 2027-01-01
- Published
- 2026-05-05
- Current As Of
- September 2026
Scope: Priority Health Maternity Services Policy 071. Review the member benefit and the policy’s self-funded-plan limitation before applying.
Maternity Services — Billing Policy 071. Verify the payer source before claim submission.
Frequently asked questions
Priority Health payer FAQs
Can I automate Priority Health portal follow-up?
Yes — portal retrieval is required when 276/277 is missing or stale. See payer portal automation and learn why 276/277 is not enough.
What is the payer ID for Priority Health?
The primary payer ID for Priority Health is 38217. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What is the provider portal for Priority Health?
The provider portal for Priority Health is https://apps.availity.com/. Available features depend on the payer and your account.
What are the 837 payer IDs for Priority Health?
The 837P and 837I payer ID for Priority Health is 38217 via Stedi.
What is the 835 payer ID for Priority Health?
The 835 payer ID for Priority Health is 38217 via Stedi.
What is the 270 payer ID for Priority Health?
The 270 payer IDs for Priority Health are 38217 via Stedi and PRHTH via Availity.
What is the 276 payer ID for Priority Health?
The 276 payer ID for Priority Health is 38217 via Stedi.
What state does Priority Health operate in?
Priority Health operates in MI.
Routing reference
Priority Health payer IDs and operating states
Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.
| Payer name | Priority HealthSource: Substrate payer directory · data last changed |
|---|---|
| Operating states | MISource: Substrate payer directory · data last changed |
| 837P professional claims payer IDStedi | 38217Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 837I institutional claims payer IDStedi | 38217Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | 38217Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | 38217Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDAvaility | PRHTHSource: Availity payer catalog · catalog dated · matched by payer name |
| 276 claim status payer IDStedi | 38217Source: Stedi payer catalog · catalog dated · matched by payer ID |
Routing sources and verification
- Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Data last changed ; checked .Open payer website ↗
- Stedi payer catalogMatched by payer ID; matched record: Priority Health. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
- Availity payer catalogMatched by payer name; matched record: PRIORITY HEALTH. Source dated .The attached API workbook supplies 270 and 276 payer IDs only. It does not supply 837P, 837I, or 835 IDs.Open current Availity reference ↗
Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.