How to ask us to reconsider coverage and payment.

Submitting claims

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, Chapter 26, 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.

How to submit electronic claims

Learn how to set up HIPAA-compliant electronic (EDI) claim files.

Set up instructions

Where to mail paper claims

Priority Health Claims

P.O. Box 232

Grand Rapids, MI 49501

Resources for out-of-state providers

Service-specific billing