How to ask us to reconsider coverage and payment.
- All claims must be electronic or typed on paper
- Do not fax or email claims, original or corrected
- Use the member ID number to identify the patient
- Total charges should appear only on the last page
- Secondary claims must be billed with primary EOB
- National Uniform Billing Committee (NUBC) standard code sets
- Multiple services on the same day must bill on one claim
- Use Place of Service codes
- Use the modifier FB
Priority Health will not accept hand-written claims.
Send claims only electronically or, for paper claims, through the U.S. Mail.
Don't use a Social Security number. We reject electronic and paper claims submitted without a valid subscriber ID (with two-digit suffix) or Medicaid recipient ID number.
Omit the total charges until the final page of multi-page paper claims.
Billed charges must match the amount shown as billed on the EOB. If they don't, your claim will be rejected as "Inappropriate EOB - does not match claim." You will then have to rebill the claim.
If a claim denies for needing the primary EOB, you must resubmit the claim with the EOB attached via electronic or paper claim submission. We do not accept EOBs via fax or email.
Valid ICD-10, CPT, and HCPCS codes only
Claims containing invalid codes will be denied upfront, and we will notify you within 48 hours of the denial. See the Diagnosis coding guidelines in this section.
Effective May 1, 2018, multiple services reported by the same provider for the same day of service will be denied or adjusted to deny if services are split between multiple claims.
See the Medicare Claims Processing Manual, Chapter 26, sections 10.5 and 10.6.
When you received a drug or item at no cost and are billing that charge for informational purposes, not for reimbursement, use the modifier FB.
How to submit electronic claims
Where to mail paper claims
Priority Health Claims
P.O. Box 232
Grand Rapids, MI 49501
Set up electronic funds transfers
Set up electronic claims/RAs
ACA non-payment grace period
Check reissue procedure
Correcting overpayments and underpayments
COB: Coordination of benefits
NDC numbers on drug claims
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