04/03/2018

Managed Care Committee Reimbursement "TIDBITS"

Featuring this month: Priority Health

Did you know… Effective May 1, 2018, Priority Health will require that all services provided on the same date of service by the same provider be reported on a single claim billed on a CMS-1500 or 837 transaction.  More information and examples are available on their website!

Did you know… Priority Health Advantage Plan was rejecting claims for ESA's for non-chemo induced anemias due to the National Coverage Determination issue pending at CMS, BUT - an update from Dr. Fox, Priority Health Vice President, Associate Chief Medical Officer, was received on 3/29/18....

"I regret we originally took the opposite approach, deny until proven otherwise.  We will now approve until Medicare tells us otherwise."

Visit the Priority Health Website at... CLICK HERE

TidBits thanks to

MSHO Managed Care Committee Member

ROBIN FREY, CHONC, CPS

NOTE: A different Michigan Payer will be featured monthly.

 Visit the MSHO Website for a listing of the Michigan Health Plans and the MSHO Managed Care Committee.

CLICK HERE