Billing & payment news
Seeing in prism why a claim denied is easier than ever
We recently improved the Claims section in prism, pulling all claim denial details and rationale into one place. No additional buttons to click or external resources to access.
June 2025 billing policy updates
We recently published or updated several billing policies, now available in our Provider Manual.
Reprocessing physical therapy claims
We’re reprocessing physical therapy claims from the past few weeks due to a payment error.
Reprocessing CRNA claims
We're reprocessing 2025 CRNA claims due to a payment error.
RAs for May CM checks are being delivered late
Remittance advices (RAs) for our May 2025 care management (CM) payment checks are being delivered late. Checks have already been delivered.
CS modifier no longer valid
Effective July 28, 2025, claims submitted with the CS modifier will be denied. You’ll see denial code “E1J – Modifier used inappropriately” in prism.
DPP program billing reminder
Follow MDHHS billing guidelines for our Diabetes Prevention Program for Medicaid members.
May 2025 billing policy updates
We recently published or updated a series of billing policies, now available in our Provider Manual.
New and updated billing policies
Several billing policies were recently published to or updated in our Provider Manual.
Update to corrected claims goes into effect June 2
Effective June 2, 2025, all submitted claims requiring a correction – both facility and professional, regardless of any allowed / paid amount on the original claim – will require submission of a corrected claim with frequency code 7.
New and updated billing policies now available
We recently published several new and updated billing policies.
Claim dispute decisions are delivered in prism
We’re sharing a reminder that claim dispute (appeal) decisions are sent through our provider portal, prism.