Medicare non-contracted provider payment disputes

Submit your non-contracted payment dispute to us electronically. If you don't have a Priority Health provider account, a.k.a. prism account, create one now.

  • Type 1: Complex claim dispute or disputes associated with timely filing, location errors, fee disputes, filing error, etc.
  • Type 2: Coding or clinical edit related requests


Submit your provider dispute request within 60 calendar days from the date of the remittance advice.

Submit disputes online (preferred)

Work with us quickly and easily. Filing your disputes online through your prism account will ensure a faster response.

Complex claim disputes

Use the process below to file a complex claim dispute or disputes associated with timely filing, location errors, fee disputes, filing error, etc.:

  1. Log into your prism account.
  2. Under the Claims tab, click Medical Claims.
  3. Find the claim in question on the claims listing page. You can use the search bar in prism to enter your Claim ID or any element on the claims list page to filter your claims. When you find the right claim, click on the Claim ID link.
  4. From the Claims Detail, click Contact us about this claim. This will open a new window.
  5. Choose “Other related claims questions" in the “What is your message about” drop-down menu.
  6. Complete all fields, attach any documentation, write us a message and click Send.

Your inquiry will appear in the General Requests section of prism after submission. You'll get an automated response with a claim inquiry reference number. A provider operations analyst will respond to your inquiry within 15 calendar days. If your inquiry requires investigation by another department, we'll notify you within 15 calendar days.

Coding or clinical edit related requests

Get all of your coding or clinical edit related questions answered using our secure mailbox.

  1. Log in to your prism account.
  2. Select General Requests to access our secure mailbox.
  3. Click New Request.
  4. Choose "Clinical Edits" from the drop down menu. 
  5. Complete all fields. Explain your question about coding, clinical edit rationale or clinical edit upfront rejection denials (ex. Unbundling, MUE, global period, modifier usage, etc.). Attach any documentation.
  6. Click Send.

You'll get an automated email with a claim inquiry reference number. A coding analyst will reply with an explanation within 45 calendar days. If you haven't received a response within 45 days, reply to the email that contains your inquiry number.

Mail your provider dispute request to us

If you're unable to submit a non-contracted provider payment dispute electronically through the processes described above, follow our standard payment reconsideration process outlined below.   

Priority Health NCP Payment Dispute
1231 E. Beltline Ave NE
MS 2315
Grand Rapids, MI 49525

Fax: 616.975.8856