Billing & payment news for providers
- 09/15/2022: Visit our updated Medicaid Billing webpage
- 09/15/2022: Unspecified Codes clinical edit coming October 11
- 08/29/2022: Save remittance advice files within 90 days
- 08/16/2022: New clinical edit goes into effect Oct. 15, 2022
- 08/10/2022: New clinical edit coming Oct. 1, 2022
- 07/15/2022: Duplicate RAs in Filemart, slight paper check delays this week
- 07/13/2022: Legacy THC providers must wrap up claims, appeals by Dec. 31, 2022
- 07/12/2022: New clinical edits coming Sept. 15, 2022
- 07/12/2022: Medicaid claims rejection issue resolved
- 06 30 2022 provider news New clinical edits announced in June 2022
- 06 03 2022 provider news New clinical edits going into effect
- 06/03/2022: Medicaid claims rejection issue resolved
- 05/09/2022: New billing guidance for follow-up colon cancer screenings
- 05/13/2022: We're working to resolve Medicaid claims being rejected incorrectly
- New clinical edits for professional and facility claims
- 05/20/2022: New clinical edit and medical policy for pain management
- 04/14/2022: New virtual care billing requirement or FQHCs and RHCs
- 04/06/2022: Appeal vs claim inquiry: Steps for faster claim resolution
- 04/06/2022: Change to referring/ordering/attending editing for Medicaid claims
- 04/13/2022: Reporting other insurance on Medicaid claims for vision, NEMT and MIHP providers
- 12/15/2021: What makes a good appeal? Tips from our Reimbursement team
- 04/05/2022: Paper claim payments delayed
- 12/15/2021: Medicare therapy threshold changes effective Jan. 1, 2022
- HealthbyChoice payments coming in January |Provider News
- 12/02/2021: CMS is resuming standard sequestration
- 11/23/2021: Multi-panel lab tests for viral infections aren't covered
- 11/08/2021: Medicaid edit 21007 is a front-end rejection
- 10/28/2021: Changes to COVID-19 vaccine and lab testing billing coming Jan. 1, 2022
- 11/02/2021: New payment policy for unbundled services going into effect Jan. 1, 2022
- 03/16/2022: Bill bilateral procedures separately starting Jun. 1, 2022
- 02/28/2022: Incorrectly denied DME claims will reprocess automatically
- 11/05/2021: Chiropractors updated CMS LCD now in effect
- 02/28/2022: Resubmit claims for Medicaid members with other insurance
- 09/01/2021: Changes to appeals process coming Nov. 1
- 01/31/2022: Anatomic modifiers required starting Apr. 1, 2022
- 01/05/2021: Appeals tips for Medicare non-contracted providers
- 08/18/2021: COVID19 treatment $0 cost share will end on Sept. 30, 2021
- 01/12/2022: Use POS 10 for virtual visits in the patient's home
- 07/16/2021: MDHHS has updated the billing requirements for G2025
- 01/19/2022: New COVID-19 vaccine CPT code for 5-11-year-olds
- 06/23/2021: Hand surgery rates
- 01/19/2022: Submitting claims for Medicaid members with other insurance
- 05/05/2021: New Medicaid edits
- 02/19/2021: March 1 newborns on mother's remit
- 12/30/2020: Updated Medicare therapy threshold
- 12/11/2020: Updated Medicare therapy threshold process
- 12/11/2020: New 2021 changes to E/M codes
- 12/02/2020: Extensions for $0 cost sharing for COVID-19 treatment
- 10/29/2020: 2021 commercial fee schedules now available
- 09/29/2020 Claims processing for providers at temporary locations for COVID-19 ends Sept. 30
- 08/27/2020 Reviewing 2021 changes to E/M codes
- 07/30/2020 Billing reminders for providers treating QMBs
- 04/13/2020: Changes coming to how we display corrected claims in your remittance advices
- 04/07/2020: COVID-19 update: Care management codes billable virtually, additional telemedicine clarification
- 03/23/20: COVID-19 updates: Add CR modifier to COVID-19 diagnosis claims and more
- 03/20/2020 Changes to CMS's National Correct Coding Initiative resulting in some claims reprocessing
- 03/10/2020: COVID-19 information for providers
- 03/10/2020 Changes to remit codes for FQHCs, RHCs and THCs
- 02/11/2020: Some commercial claims denied in error, to be reprocessed
- 12/30/2019: Medicare therapy cap changes effective March 1, 2020
- 12/04/2019: Changes to remittance advice (RA) and explanation of benefit (EOB) codes effective the week of Dec. 2
- 11/19/2019: Skilled nursing facility claims are being incorrectly denied
- 11/19/2019: New! View front-end rejections and reasons online
- 11/11/2019: Facilities: 340 drug pricing program is changing
- 11/01/2019: 2020 commercial plans fee schedules are now online
- 10/03/2019: Additional services payable for Medicare moved from inpatient to outpatient Oct. 1
- 10/02/2019: Changes to RA and EOB codes for commercial and Medicare APC claims effective Nov. 1, 2019
- 10/02/2019: Changes to RA and EOB codes effective Oct. 7, 2019
- 10/01/2019: Increasing fee schedule for CPT codes 26055 and 64721 beginning Oct. 1
- 09/11/2019: Reminder: Modifier 26 not payable at most lab services
- 07/31/2019: No changes to skilled nursing facility payments with CMS’s Oct. 1 changes
- 03/26/2019: Medicare therapy cap changes and claims reprocessing
- 02/25/2019: Preclusion list denials and termination
- 02/13/19: PH confirms accurate PCMH payments
- 02/04/2019: 340b drug modifier required and upcoming recoupment
- 01/18/2019: Medicaid reimburses for LARC
- 01/08/2019: We've heard you, and we're making changes to our "Medicaid 180-day rule" based on your feedback
- 12/10/2018: Annual Jan. updates for Commercial/Medicare/Medicaid
- 12/06/2018: JVHL Medicaid contract termination Jan. 1
- 11/26/2018: Medicare therapy cap changes effective Jan. 1, 2019
- 11/19/2019: Reminder: Priority Health does not accept condition code 44
- 11/08/2018: 4 tips for faster response to inquires sent into Priority Health
- 11/07/2018: Chiropractic maintenance claims being improperly denied to provider liability
- 11/02/2018:Reminder: Send explanation of benefits (EOB) when Priority Health is secondary
- 10/25/2018: Some Medicaid claims are being incorrectly denied
- 10/15/2018: Claims billed with S5111 not payable after Jan. 1, 2019, new code required
- 10/15/2018: Billing claims when a member ID card contains Cigna information
- 10/08/2018: Reminder: Bill Medicare influenza and pneumonia vaccines with covered codes
- 09/06/2018: Reminder: Chiropractic changes coming Oct. 1, 2018
- 09/06/2018: Medicaid inpatient LARC device reimbursement
- 07/12/2018: Medicaid FQHC/RHC/THC updates
- 07/31/2018: Some Medicare claims denied in error
- 07/27/2018: Update: Billing same-day sevices
- 07/09/2018: Updates to facility claim clinical edits
- 07/09/2018: Reminder: Tobacco cessation counseling billing
- 06/13/2018: Multiple radiology interpretations for same service
- 06/12/2018, Updated: Chiropractic AT modifier requirement now Oct. 1
- 05/09/2018: Medicare medication reconciliation billing change
- 05/08/2018, UPDATED: Reprocessing Federal/Rural/Tribal health center claims
- 05/07/2018: Practitioner Medicare billing edit change effective June 1
- 10/24/2017: Reminder on corrected claims and record submission
- 04/20/2018: PCCM collaboration support
- 04/16/2018: Incorrect PriorityHSA deductibles
- 04/02/2018 Care management claims rejected in error
- 03/01/2018: New unlisted codes claims process for facilities
- 03/01/2018: Services reported on split claims
- 02/28/2018: Enteral nutrition therapy S9340 doesn't cover pre-mixed formula
- 02/21/2018: New remittance advice codes for Medicare/Medicaid dual-eligibles
- 02/05/2018: Pressure-reduction device auth change
- 01/26/2018: Care management claims processing changes
- 01/01/2018: 2018 Update for commercial/Medicare APC hospital rates
- 2017