Below are Priority Health's medical claims payment policies. This information may help providers bill claims more accurately to reduce delays in processing, as well as avoid rebilling and additional requests for information.
A
- Advance care planning (ACP)
- Add-on codes
- After hours and weekend care professional
- Advanced Practice Professional (APP)
- Allergy injection and immunotherapy
- Always / sometimes therapy
- Ambulatory surgical centers
B
- Balance billing
- Behavioral health
- Bladder scans
- Blepharoplasty, blepharoptosis and brow lift
- Botulinum toxin type A & type B
C
- Cardiac rehabilitation
- Cardiology
- Care management services
- Chiropractic services
- Chronic pain management services
- Claim submission guidelines
- Clinical edit
- Clinical trials
- Compression garments
- Concierge medicine
- Condition codes
- Continuous glucose monitor (CGM) supplies
- Critical access hospital (CAH) method II billing
- Critical care
D
- Diabetes education
- Distinct unbundled modifiers
- Drug testing
- Drugs administered by providers for FDA-approved or medically accepted off-label uses
- Duplicate claims
- Durable medical equipment (DME) / prosthetics & orthotics modifiers
- Durable medical equipment (DME) place of service (POS)
- Durable medical equipment (DME) refill requirements
E
- ECG interpretation
- Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)
- E/M services billed with treatment room codes
- Endomyocardial biopsy with right heart catheterization
- Enteral nutrition
- Epidural steroid injection for pain management (ESI)
- Evaluation and management
- Excludes1
F
G
H
- High tech radiology services
- HIV prognosis and monitoring
- Home health
- Home infusion
- Hospice care
- Hypoglossal nerve stimulation for treatment of obstructive sleep apnea
I
L
M
- Magnetoencephephalography (MEG)
- Malnutrition
- Maternity and prenatal care
- Medicare Annual Wellness Visit (AWV) / preventive care visits
- Mechanical vent and length of stay
- Micro-invasive glaucoma surgery
- Miscellaneous DME
- Miscellaneous DME supplies
- Moh's micrographic surgery
- Musculoskeletal shoulder
- Musculoskeletal spine
N
- Nebulizers
- Negative pressure wound therapy pumps
- Non-invasive peripheral arterial vascular studies
- Nutrition counseling, education and therapy
O
- Observation stays
- Once per lifetime
- Ophthalmology and vision
- Ordering / referring provider requirements
- Osteogenesis
- Osteopathic manipulation treatment (OMT)
- Ostomy supplies
- Oxygen and oxygen supplies
P
- Paid amount exceeds billed amount
- Partial Hospitalization Program (PHP)
- Pelvic and transvaginal ultrasound
- Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
- Portable radiology services
- Positive airway pressure (PAP) devices for treatment of sleep apnea
- Preventive services
- Professional and technical components status indicator
- Professional status indicator
- Prostate biopsy pathology
- Prosthetic orthotics and footwear
- Provider-based billing
- Psychiatry and Psychology services
R
- Radiation oncology
- Radiology PC / TC multiple same-day billing
- Readmissions reimbursement
- Removal of benign skin lesions
S
- Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- Semiprivate vs private room
- Sepsis
- Site neutral medical drug
- Skilled nursing facility
- Split billing
- Surgical dressings
- Surgical implants & devices
T
- Three-day window bundling
- Tracheostomy care supplies
- Trauma team activation
- Treatment rooms
- Trigger point injection services