Priority Health - How to bill

When you're logged in, you can use the Claims tool to check the status of claims you have already submitted and get a Pended Claims report.

General guidelines

All claims must be typed or electronically generated; Priority Health cannot accept hand-written claims.
Billed charges must match the amount shown as billed on the EOB you have submitted, or your claim will be rejected as "Inappropriate EOB - does not match claim." You will then have to rebill the claim.
Coding requirements: Priority Health guidelines require that providers report valid CPT, ICD-9, and HCPCS codes when coding for services rendered. Claims containing invalid codes will be denied up front, and we will notify providers within 48 hours of the denial. See the Diagnosis Coding guidelines in this section.

Timing of claim submission

Services must be billed within one year of the date of service.
Providers may re-submit a claim if no response has been received within 45 days of submission.
Follow-up, including resolving all claim discrepancies, must be completed within one year of the date of service. After that anniversary date claims will be denied as provider liability. There are no exceptions for negligence by provider billing services or provider staff.
When another payer is primary and they make or recover payment near or after our filing limit, you have 90 days from the date on the primary EOB to submit the claim to us.

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Last modified 02/05/09

How to bill Priority Health