Mid-level provider billing
Surgical assists or facility rounding
Physician assistants or nurse practitioners employed by a physician group that is participating with Priority Health must contract and bill directly for surgical assists and/or facility rounding.
To contract with us, use the Credentialing Supplemental Information Form.
Assists with surgery should be billed using the HCPCS Level II modifier -AS, a non-physician assistant at surgery (this would include PA, CNS, CRNFA, RNFA, NP, DDS, DMD, and surgical technician provider types, subject to contract eligibility).
All office-based services need to be billed under the supervising participating physician or other contracted primary care provider. The supervising physician must be billed as the rendering physician.
Most services are reimbursed at 85% of the professional fee schedule.
Some services may be paid at the 100% of the physician fee schedule, if you are contracted to provide them:
- Labs, including venipuncture and radiology
- Immunizations, vaccines and toxoids
- Injectables, supplies and ancillary services
Nurse practitioners or physician assistants who have been credentialed and contracted by Priority Health as a primary care provider should bill us directly. These services are paid at 100% of the physician fee schedule.
Priority Health will credential CNMs if they meet credentialing criteria. If credentialed, reimbursement will be at 100% of the regional physician fee schedule. If the CNM is not credentialed, services must be billed under supervising physician.
Submitting electronic claims
Mailing paper claims
Priority Health Claims
P.O. Box 232
Grand Rapids, MI 49501
- Status claims
- Claims Inquiry tool guide
- Edits Checker tool guide
- Claim deadlines
- Set up electronic payments
- BH provider billing
- Facility billing
- Mid-level provider billing
- Professional billing
More billing topics:
- ACA non-payment grace period
- ADA dental claim billing
- Balance billing
- Clinical edits
- Check reissue procedure
- COB: Coordination of benefits
- Correcting claims
- Correcting overpayments & underpayments
- Diagnosis coding
- Front-end rejections
- Gender-specific services
- Medicaid billing
- NDC numbers on drug claims
- Office-based procedures billing
- Risk adjustment
- Unlisted codes, drugs & supplies