Billing & payment news
Update: EOBs no longer accepted through prism inquiries for claim reprocessing
Effective May 5, 2026 we'll no longer accept an EOB attached to a prism inquiry for claim adjustment. If a claim is denied for needing the other payer’s information, providers must resubmit the claim electronically with the other insurance payment information included.
February 25, 2026
02/11/2026: February 2026 billing policy updates
We publish billing policies to offer transparency and help you bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.
February 10, 2026
We've made changes to our claim appeals process
We’ve made some changes to our claim disputes process to streamline options for you and align with industry best practices. We’ve also made changes to the requirements for escalating claims.
January 28, 2026
We’re reprocessing some Medicare claims impacting fee-for-service providers
We identified an error in how some Medicare fee schedule rates were loaded into our system. The base physician facility and non facility rates were accidentally reversed, impacting two fee schedules and approximately 2,000 CPT and HCPCS codes.
January 23, 2026
01/14/2026: January 2026 billing policy updates
We publish billing policies to offer transparency and help you bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.
January 14, 2026
New payment and RA processes coming Aug. 1, 2026
We’ve partnered with Optum Financial and ECHO Health, Inc. to provide payment and payment reconciliation services to you, our provider network.
January 13, 2026
Code 0523T not separately payable
We're correcting an issue with CPT code 0523T which was requiring a prior authorization in error. This code is not separately payable form the primary procedure for all products.
December 10, 2025
New process for submitting Part D immunizations for PriorityMedicare members
Effective January 1, 2026, providers must bill Part D immunizations for PriorityMedicare Dual Premier (HIDE-SNP) members through TransactRx when vaccines are administered in a physician’s office. Claims submitted directly to us will deny as provider liability, and providers may not bill members for any vaccine costs or administration fees. The TransactRx process is available for all PriorityMedicare members.
December 10, 2025
12/18/2025: December 2025 billing policy updates
We publish billing policies to offer transparency and help you bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.
December 9, 2025
11/13/2025: November 2025 billing policy updates
We publish billing policies to offer transparency and help you bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.
November 5, 2025
11/5/2025: Recouping care management payments from FQHC/RHC/THC
We recently discovered we’ve been paying the following transition of care codes* when billed by FQHC / RHC / THCs for Medicaid, when we shouldn’t:
November 5, 2025
11/01/2025: 2026 commercial fee schedules are available online
2026 commercial fee schedules are available online
October 29, 2025