Non-contracted provider payment disputes
Submit your non-contracted payment dispute to us electronically. If you don't have a Priority Health provider account, request 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
Complex claim dispute or disputes associated with timely filing, location errors, fee disputes, filing error, etc.
Work with us quickly and easily. For complex claim disputes or general disputes associated with timely filling, location errors, fee disputes and filling errors follow the process below for a faster response.
- Log into your prism account
- From the Claims Detail, click Contact us. 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.
- Log in to your prism account and select Messages to access our secure mailbox. Simply, compose your message and choose "Clinical edit" from the drop down menu.
- Explain your question about coding, clinical edit rationale or clinical edit upfront rejection denials (ex. Unbundling, MUE, global period, modifier usage, etc.). 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 are unable to submit a non-contracted provider payment dispute electronically, follow our standard payment reconsideration process outlined below.
Submit your provider dispute request within 60 calendar days from the date of the remittance advice.
Priority Health NCP Payment Dispute
1231 E. Beltline Ave NE
Grand Rapids, MI 49525