Billing & payment news
Claim dispute decisions are delivered in prism
We ’re sharing a reminder that claim dispute (appeal) decisions are sent through our provider portal, prism.
June 25, 2025
We're reprocessing select doula telemedicine claims due to an error in the fee schedule
Due to a reimbursement rate error in the Michigan Department of Health and Human Services’ (MDHHS) fee schedule, we’re reprocessing doula telemedicine claims submitted under the HCPCS code S9945 between Oct. 1, 2024 and Feb. 28, 2025.
June 25, 2025
Resolving Medicaid claims rejecting incorrectly for date of death
We’re resolving an issue with some Medicaid claims rejecting incorrectly for missing or invalid date of death. We'll reprocess impacted claims; there's nothing you need to do.
June 25, 2025
New and updated billing policies are now available
The following billing policies were recently published to or updated in our Provider Manual.
June 25, 2025
RAs for January CM checks are being delivered late
Remittance advices (RAs) for our January 2025 care management (CM) payment checks are being delivered late. Checks have already been delivered.
June 25, 2025
January billing policies update
The following billing policies were recently published to or updated in our Provider Manual.
June 25, 2025
Corrected claims must include the original claim ID
As a reminder, we require that corrected claims – submitted to either replace, correct or void an original claim that was partially or fully paid – include the original claim ID. We’ll soon begin front-end rejecting corrected claims that have an invalid / incorrect original claim ID.
June 25, 2025
Telemedicine billing updates effective Jan 1
At Priority Health, we align our telehealth / virtual services billing guidelines with AMA, CMS and MDHHS. AMA and CMS recently released updates effective Jan. 1, 2025.
June 25, 2025