We've heard you, and we're making changes to our "Medicaid 180-day rule" based on your feedback
Effective immediately, you'll no longer have to wait 180 days to resubmit denied Medicaid claims that are subject to a third-party liability (TPL) investigation. Now, if you submit a Medicaid claim that requires TPL review, your claim will be pended, reviewed and paid if no other liable parties are identified. Claims will continue to deny if our review determines there's another primary payer, including motor vehicle, worker's compensation or school-related injuries. Any open claims previously denied by Priority Health for the Medicaid 180-day rule may be resubmitted at this time for payment consideration.
We appreciate your feedback and look forward to our continued partnership in the New Year.