Billing & coding policies
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 injections / immunotherapy
- Always / sometimes therapy
- Ambulatory surgical centers
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
- Evaluation and management
- Excludes1
F
G
H
I
L
M
- Magnetoencephephalography (MEG)
- Malnutrition
- Maternity and prenatal care
- Medicare Annual Wellness Visit (AWV) / preventive care visits
- Miscellaneous DME
- Moh's micrographic surgery
- Musculoskeletal shoulder
- Musculoskeletal spine
N
O
- Observation stays
- Once per lifetime
- Ophthalmology and vision
- Ordering / referring provider requirements
- Osteopathic manipulation treatment (OMT)
- Ostomy supplies
- Oxygen and oxygen supplies
P
- Partial Hospitalization Program (PHP)
- Pelvic and transvaginal ultrasound
- Portable radiology services
- Positive airway pressure (PAP) devices for treatment of sleep apnea
- Professional and technical components status indicator
- Professional status indicator
- Prostate biopsy pathology
- Prosthetic orthotics and footwear
- Provider-based billing
- Psychiatry and Psychology services
R
S
- Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- Semiprivate vs private room
- Sepsis
- 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
U
W
- 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
- Drug Coverage
- Dual-eligible members
- Front-end rejections
- Gender-specific services
- Medicaid billing
- Modifiers
- NDC numbers on drug claims
- Office-based procedures billing
- Risk adjustment
- Unlisted codes, drugs & supplies