Effective Aug. 1, 2026, we’ve simplified our claim dispute process by removing the requirement to attach applicable Priority Health billing and coding policies and/or medical policies when submitting a Level 1 and Level 2 claim dispute.
Providers are still required to submit a complete rationale and all supporting documentation necessary for review.
Here’s an overview of our updated process
- Follow guidelines provided on our Level 1 claim disputes webpage to initiate a claim dispute in prism
- Include the disputed code(s)
- Provide a detailed rationale for the dispute
- Reference the applicable Priority Health billing or medical policy, noting specific sections or details when applicable
- Attach supporting documentation, like regulatory guidance, non-Priority Health billing and coding guidelines, contract language or fee schedules
By removing this requirement, we hope to streamline your dispute submission process while still ensuring reviewers have the information needed to evaluate the dispute accurately.
For more information or guidance, visit the Claim Dispute Process section of our website.