04/17/2023

Priority Health Update

Priority Health Managed Care Committee Member

Flora Werle - Cancer & Hematology Centers of West Michigan

New Date Format for Payment Reference IDs
On April 1, 2023, our payment reference IDs that accompany claim and capitation payments will change.

What’s changing?
The date-related characters in the payment reference ID will change from an 8-character pay date (YYYYMMDD) to a 5 character pay date that uses Julian date logic (YY Julian date).

For example:

• Pre 4/1/2023: 2021060410300531
• 4/1/2012 and after: 21155B1000000531

The new payment reference IDs may also have a B which identifies the payment as a batch source.

We anticipate this change should have a low impact for you as you’ll retain the ability to match the payment reference ID against EFT remittance advices in Filemart.

Clinical Documentation Will be Required for Outpatient Authorizations Starting June 1
As Michigan’s Prior Authorization Reform legislation (SB 247 / PA 60) goes into effect on June 1, 2023, we’ll implement new requirements for some of our prior authorizations to help ensure timely, appropriate care for our members, your patients.

9-day turnaround time
Starting June 1, in accordance with PA 60, we’ll decrease our prior authorization turnaround time from 15 days to 9 days for our commercial, individual / ACA and governmental self-funded plans.

Clinical documentation requirement
To support this shift, also starting June 1, we’ll require in-network providers to upload clinical documentation supporting medical necessity to their medical and behavioral health outpatient prior authorization requests in GuidingCare.

This requirement, which will apply to all plans, will reduce the need for follow-ups requesting additional information, ultimately reducing administrative burden and wait times for your teams and ours.

Get more information
For more information on the work we’re doing to support PA 60, and the ways in which we’re already meeting the mark, see our recent news item.

Click here to visit the Priority Health Provider News Page for additional updates.