Reminder: Out-of-network providers must submit medical records with claims

Out-of-network (OON) providers submitting a claim for a Priority Health member must include medical records with the claim. When we receive a claim from an OON provider without the appropriate medical records, we issue a request. Failure to submit requested documentation may result in an audit and claim denial.

If you've received a denial, you can rebill the denied claim with the requested medical records to be reimbursed appropriately.