2018 Update for commercial/Medicare APC hospital rates

Priority Health is not going to hold commercial and Medicare institutional claims at the beginning of the year as we have in previous years while waiting for the release of new hospital APC rate files.

Our vendor, Optum Health, is currently expecting to release the new rate files on 01/09/2018. Priority Health has 30 days to complete the upload after receipt of the files, and we are committed to loading changes as quickly as possible. Additionally, we are also now completing rate uploads twice a month to reduce the impact that providers have experienced in the past.

Claims will not be adjusted
Per Priority Health policy, we will not be making any adjustments for claims paid at the old rate during the 30-day period while we are loading the new rates to our system. Providers may instead choose to hold claims until February to ensure they're processed under the new 2018 APC rates.