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.
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.
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.
New and updated billing policies are now available
The following billing policies were recently published to or updated in our Provider Manual.
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.
January billing policies update
The following billing policies were recently published to or updated in our Provider Manual.
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.
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.