If you are a Michigan-based provider reference the information below. If you're a provider practicing outside of the state of Michigan see our out-of-state information.
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 upfront, 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.
Use the modifier FB
When you received a drug or item at no cost and are billing that charge for informational purposes, not for reimbursement, use the modifier FB.
Also see service-specific billing information for:
Submitting electronic claims
Mailing paper claims
Priority Health Claims
P.O. Box 232
Grand Rapids, MI 49501
For pharmacy payer sheets and billing assistance, visit the ESI Pharmacy Resource Center
Billing & payment news
- Status claims
- Claims Inquiry tool guide
- Edits Checker tool guide
- Claim deadlines
- Set up electronic payments
- BH provider billing
- Facility billing
- Advanced practice professional billing
- Professional billing
More billing topics:
- ACA non-payment grace period
- Ambulatory surgery center billing
- Balance billing
- Clinical edits
- Check reissue procedure
- COB: Coordination of benefits
- Correcting claims
- Correcting overpayments & underpayments
- Diagnosis coding
- Dual-eligible members
- Front-end rejections
- Gender-specific services
- Medicaid billing
- NDC numbers on drug claims
- Office-based procedures billing
- Risk adjustment
- Unlisted codes, drugs & supplies