07/24/2018

Priority Health

News Updates

Priority Health Split Claim Policy

Problem:  PH now requires that all services be billed on one claim; claims cannot be split.  Split claims are being denied and providers need to resubmit a corrected claim for all services causing a billing nightmare for many of our members.

7/24/18 - Effective immediately, Priority Health has agreed to remove this edit and allow providers to bill on more than one claim!  Going forward, Priority will continue to recommend the services be billed on the same claim however, they will not deny any services billed on a separate claims going forward.  They stated, "We are recommending that all services be billed on the same claim, as not doing so inflates healthcare cost and confuses members."

As far as dealing with any denials, Priority states: 

From the time the edit was put in place until now, if a claim was denied, the provider is responsible for resubmitting the claim, either:
---As a corrected claim - all on one claim (preferred method)
---On a separate claim form.
     

THANK YOU - to Robin Frey and Margaret Agnone for your help in addressing this issue with Priority Health!! 

This information has been provided by

MSHO Managed Care Committee Member:

Robin Frey, CPC, CHONC
Reimbursement Manager
Cancer & Hematology Centers of Western Michigan, PC