Annual Jan. updates for commercial/Medicare/Medicaid hospital rates and new codes 

Priority Health will not be holding commercial, Medicare or Medicaid institutional claims at the beginning of the year, as we've done in previous years, while waiting for the release of new hospital rates files and new CPT/HCPC codes.

Our vendor, Optum Health, is currently expecting to release the new rate files as follows:

  • Medicare and commercial on Jan. 8, 2019
  • Michigan Medicaid on Jan. 24, 2019

Priority Health has 30 days to complete the upload after receipt of the files, and we're committed to loading changes as quickly as possible.

Additionally, we're completing rate uploads twice a month to reduce any impact that you may have experienced in the past.

Claims will not be adjusted

Per our policy, we will not be making any adjustments for claims paid at the old rate during the 30-day period while we're loading the new rates and CPT/HCPCs codes to our system. Providers may choose to hold claims until February to ensure they're processed under the new 2019 rates or reimbursed for new CPT/HCPCs codes.