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Medical policy changes
Breast Related Procedures
Continuous Glucose Monitoring
Eating Disorders
Parenteral Nutritional Therapy in Home
Stimulation Therapy and Devices
Changes to become effective 9/19/08:
Cardioverter Defibrillators 91410 - additional criteria added
Intravenous Immunoglobulin (IVIG) 91514 - additional criteria added
Deleted 7/15/08
Lab codes 83715 and 83716 no longer billable
Added 7/15/08
Get Started guide
Updated 7/9/08
List of injectable drugs requiring prior auth
Added 7/7/08
Use of modifiers 54 and 55
Removed 7/1/08
Some behavioral health auth requirements for backdating auths and outpatient reviews
Updated 7/1/08:
Prior auth requirements for some services (see news item)
Priority Health Claims
P.O. Box 232
Grand Rapids, MI 49501
| Authorizations | Billing & Payment | Administrative Resources |
|---|---|---|
|
Auths Reference List
Services list, with which plans require PA, and links to applicable PA forms and medical policies
Behavioral Health
Auths for BH services
Centers of Excellence
Priority Health's Spine, Weight Loss and Transplant Centers of Excellence
DME
When DME needs authorization
Drugs
Some drugs require prior auth, including injectables
Radiology
Requesting high-tech diagnostic studies thru AIM
Medical Policies
Browse the policies that guide auths for specific services
No Authorization?
What to do when a patient presents with no authorization
Find Specialty Providers
Call the Specialty Provider Locator Line to find the care your patient needs |
How to Bill
Submitting professional and facility billing; diagnosis coding guidelines
Capitation
Services paid per capita by age and gender
Clinical Editing
How Priority Health evaluates code usage
Code Modifiers
Help for using the most confusing modifiers
Coordination of Benefits
Dual coverage, car accidents, Workers' Comp, Medicare eligibles
Employee Billing
Protecting the privacy of Priority Health employee patients
Procedures & Services
Billing for after-hours, BH, DRGs, vaccines, etc.
Making Corrections
Revisions to claims, codes, payments
Appeals
Appealing a denied auth or claim |
Get Started
Everything to know when your first Priority Health patient walks in
Office Management & Standards
Credentialing, contracts, network availability, patient transfers and discharges, extension of care, record-keeping, site visits
Plans & Benefits
Information on Priority Health plans and ID cards
Performance Programs
Partners in Performance (PIP); Specialists Pay for Performance (PFP); EMR Incentive program
PriorityMedicare Manual (368KB PDF)
Medicare-specific instructions for providers, updated 10/07 |
