Priority Health to deny payment and terminate Preclusion List providers

Effective Apr. 1, 2019, Priority Health will deny payments for services submitted by providers that are included on the CMS Preclusion List and will terminate participating providers in the Preclusion List from the Priority Health network.

The CMS Preclusion List includes providers and prescribers who are prohibited from receiving payment for Medicare Advantage services or Part D drugs prescribed to Medicare beneficiaries.

Those included on the list will receive notification from CMS of their placement on the Preclusion List, via letter, and will have the opportunity to appeal with CMS before the preclusion is effective. There is no opportunity to appeal with Priority Health.

For more information on the Preclusion List and next steps if you’re included on the list, visit the CMS website.