General claim requirements

All claims must be electronic or typed on paper

Priority Health will not accept hand-written claims.

 

Do not fax or email claims, original or corrected

Send claims only electronically or, for paper claims, through the U.S. Mail.

 

Use the member ID number to identify the patient

Don't use a Social Security number. We reject electronic and paper claims submitted without a valid subscriber ID (with two-digit suffix) or Medicaid recipient ID number.

 

Total charges should appear only on the last page

Omit the total charges until the final page of multi-page paper claims.

 

Secondary claims must be billed with primary EOB

Billed charges must match the amount shown as billed on the EOB.  If they don't, your claim will be rejected as "Inappropriate EOB - does not match claim." You will then have to rebill the claim.
 
If a claim denies for needing the primary EOB, you must resubmit the claim with the EOB attached via electronic or paper claim submission. We do not accept EOBs via fax or email.

 

National Uniform Billing Committee (NUBC) standard code sets

Valid ICD-10, CPT, and HCPCS codes only
 
Claims containing invalid codes will be denied up front, and we will notify you within 48 hours of the denial. See the Diagnosis coding guidelines in this section.

 

Multiple services on the same day must bill on one claim

Effective May 1, 2018, multiple services reported by the same provider for the same day of service will be denied or adjusted to deny if services are split between multiple claims.

 

Use Place of Service codes

See the Medicare Claims Processing Manual, sections 10.5 and 10.6.

Also see service-specific billing information for: