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02/02/2022

Priority Health Update

Priority Health Managed Care Committee Member

Flora Varga

Flora Varga, Cancer & Hematology Centers of West Michigan



Anatomic Modifiers Required Starting Apr. 1, 2022

Following the American Medical Association’s CPT coding guidelines, we’ll require appropriate anatomic modifier codes on claims starting Apr. 1, 2022. We’ll implement a new clinical edit, which will apply to all claims. If you’d like to see how this applies to a sample claim, try our online Edits Checker tool.

These modifiers supply more information that includes site or side of the body a procedure was performed and meets the highest level of specificity in coding.  READ MORE


Submitting Claims for Medicaid Members with Other Insurance

When two or more health plans cover the same member, we coordinate between plans following these steps:

  1. Identify if other coverage exists
  2. Review documentation to determine the correct order of benefits
  3. Update our FACETS claim processing system with other benefits
  4. Calculate the allowable expense
  5. Process the payment

Read More including what the State wants to see on your claims!



 

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