Submit your non-contracted payment disputes related to timely filing, location errors, fee disputes or filing error to us electronically. If you don't have a Priority Health provider account, a.k.a. prism account, create one now.
Deadline
Submit your provider dispute request within 60 calendar days from the date of the remittance advice.
Inaccurate coding or billing denials for services are not disputable denials. These denials require correction through corrected claim process.
- Missing modifiers
- Missing laterality in diagnosis or modifier
- Incorrect place of service
- APC Edit Claim Denials
- Incorrect procedure codes for governmental claims (i.e. G-Codes)
This is not an all-inclusive list
What will you need?
- Claim ID for the most current claim. We’ll close claim disputes without review when a claim is resubmitted after the dispute was filed.
- Denial reason applied to the claim or claim line.
- Attach any Policy or clinical guidelines applicable to the denial.
- Attach any regulatory, billing, coding guidelines or contract language.
- Supporting documentation applicable to the service under dispute. We’ll close claim disputes submitted with the full medical record.
- Summary of why you believe the claim didn’t process in accordance with the guidelines, policy and/or contract. This should be very specific. We’ll close claim disputes with statements such as “this is coded correctly” or “please review records” as these don’t support a claim dispute rationale.
Submit disputes online (preferred)
Work with us quickly and easily. Filing your disputes online through your prism account will ensure a faster response.
Claim disputes
Use the process below to file a complex claim dispute or disputes associated with timely filing, location errors, fee disputes, filing error, etc.:
- Log into your prism account.
- Under the Claims tab, click Medical Claims.
- Find the claim in question on the claims listing page. You can use the search bar in prism to enter your Claim ID or any element on the claims list page to filter your claims. When you find the right claim, click on the Claim ID link.
- From the Claims Detail, click Contact us about this claim. This will open a new window.
- Choose “Other related claims questions" in the “What is your message about” drop-down menu.
- Complete all fields, attach documentation of how the claim deviates from our established Billing & Coding policies, regulatory, contract language or fee schedules. Write us a clear and concise summary within the message field and click Submit.
Your inquiry will appear in the General Requests section of prism after submission. You'll get an automated response with a claim inquiry reference number. A provider operations analyst will respond to your inquiry within 15 calendar days. If your inquiry requires investigation by another department, we'll notify you within 15 calendar days.
Mail your provider dispute request to us
If you're unable to submit a non-contracted provider payment dispute electronically through the processes described above, follow our standard payment reconsideration process outlined below.
Priority Health Appeals Analyst
1231 E. Beltline Ave NE
MS 1150
Grand Rapids, MI 49525
Fax: 616.975.8827