Medicaid claim resubmission after 180 days
Providers may resubmit claims subject to a third party liability (TPL) investigation only after Priority Health has received no response from the patient for 180 days. This is called the "180-day rule." On or after the 180th day after the TPL rejection, the provider may:
- Resubmit the Priority Medicaid patient claim, or
- Verbally request that the claim to be reprocessed for payment.
The 180-day rule does not apply to claims that are denied for Coordination of Benefits.
1450 - Facility claims
- Submit a corrected claim with the appropriate bill type, changing the frequency (third digit of the bill type) to reflect the change.
- Include a claim note stating "claim 180 day."
- Priority Health will adjust the original claim, denying all service lines as charges billed in error.
- Priority Health will then process the new claim for payment.
1500 - Professional claims
- Submit a corrected claim with the appropriate billing code with a note stating "claim 180 day."
- Priority Health will adjust the original claim, denying all service lines as charges billed in error.
- Priority Health will then process the new claim for payment.
Claims submitted prior to 180 days
If the replacement claim is submitted before the 180-day limit, Priority Health will not adjust the original claim. The corrected claim will be denied.
See more on submitting corrected claims and payments.
