Payer Information Guide

Credentialing

Credentialing is an essential part of aligning each provider to each payer contract. In order to complete this step, please work with each specific payer to follow their payer process accordingly. If you have questions about each process, please follow the links provided that will guide you to the payer website as applicable. If you still have further questions, please reach out to your Affinia Health Network Representative.

  • Aetna Icon
    Aetna/Cofinity
  • ASR Icon
    ASR
  • Blue Cross Blue Shield Icon
    BCBSM
  • Blue Cross Blue Shield Icon
    BCN
  • Blue Cross Blue Shield Icon
    Blue Cross Complete
  • HAP Icon
    HAP - Health Alliance Plan
  • Humana Icon
    Humana
  • Meridian Icon
    Meridian
  • Molina Icon
    Molina
  • Oscar Icon
    Oscar
  • Priority Health Icon
    Priority Health
  • United Healthcare Icon
    UHC Community Plan

Authorizations

Authorizations are required at times to ensure that essential tests are approved and reduce costs that could be considered unnecessary. Our goal at Affinia Health Network is to ease as much administrative burden as possible by providing you a grid that shows not only how to obtain these authorizations but also providing you with information that guides you to each payer directly for further and up to date information. For further updates or other tools you may find helpful, please contact your Affinia Health Network Representative.

Payers use various tools and processes for obtaining these authorizations. If you need assistance getting access to these, please visit the selected payer pages for directions.

Referrals

As a part of one of our Clinically Integrated Network Standards and Goals, we work to keep our patients in our network. In order to do this we want to provide you with the tools from our payers and also our network guide. If there is further information you are seeking, please consult your Affinia Health Network Representative.

Payer Escalation

We are committed to working with our payers to resolve your payer related issues. In order to best assist you, please help us in the following payer escalation process as appropriate.

Step 1: Please gather the information

  • Provider Name
  • Group Name
  • Type 1 NPI (Provider)
  • Type 2 NPI (Group)
  • TIN
  • Brief explanation of issue
  • Example(s)
  • Code (if applicable)
  • Claim Volume (if applicable)
  • Payer specific rules
  • Result
  • Injury #
  • Reference #

Step 2:

Aetna/Cofinity

ProviderRelations@cofinity.net
Cofinity Provider Services: 800-831-1166
Aetna Provider Services: 888-632-3862

For credentialing questions and issues:
Aetna Credentialing: 800-353-1232

affinianetworkrelations@mercyhealth.com

Blue Cross Complete

Please click here for contact phone numbers for claims issues and resolution. If you have not received resolution please send your examples and trends to your Network Relations Representative.

affinianetworkrelations@mercyhealth.com

HAP - Health Alliance Plan

Meridian

Claims Payments and Status
Meridian Health is dedicated to processing your claims in under 10 days. You may status your claims several ways:

Meridian’s Secure Provider Portal
By Phone: 1-800-203-8206
By Fax: 1-313-324-3642
By Mail:
Meridian Health Claims Department
1 Campus Martius, Suite 710
Detroit MI, 48226

affinianetworkrelations@mercyhealth.com

Oscar

Priority Health

  1. Claims status
  2. Questions about the way a claim was processed email provider.services@priorityhealth.com
  3. Questions on Authorizations
  4. Looking up benefits or checking codes
  5. New Provider or existing practice trying to add new provider
  6. Change provider information
  7. Credentialing status, email ph-pelc@priorityhealth.com
  8. Specialist office, email provider.services@priorityhealth.com
  9. Provider Portal registration or password resets, call 800-942-4765 and prompt 6
  10. Any issues not seen here, email provider.services@priorityhealth.com

*** By sending messages to Priority Health directly via the secure portal, an inquiry number will be provided when messages are sent to either ph-pelc@priorityhealth.com or provider.services@priorityhealth.com

If you have further questions, please feel free to contact your Affinia Health Network Representative.

To Request an Account with Priority Health visit: https://www.priorityhealth.com/provider/request-an-account

Step 3:

  1. Contact AHN Representative
  2. Request # (Training tool)
  3. AHN will work to escalate issue

Provider Changes

As a network we know demographic changes are occuring within the network at all times. The following resource links show how these can be updated with each payer. If you have questions, please contact your Affinia Health Network Representative.

FAQ

Here we have placed some additional information available to you from some of the payers that we work with.

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