Billing Priority Health
General claim requirements
All claims must be electronic or typed on paper
Priority Health will not accept hand-written claims.
Do not fax or email claims, original or corrected
Send claims only electronically or, for paper claims, through the U.S. Mail.
Use the member ID number to identify the patient
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.
Total charges should appear only on the last page
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.
Use National Uniform Billing Committee (NUBC) standard code sets
Valid ICD-10, CPT, and HCPCS codes only
Claims containing invalid codes will be denied up front, and we will notify you within 48 hours of the denial. See the Diagnosis coding guidelines in this section.
Multiple services on the same day must bill on one claim
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.
Use Place of Service codes
See the Medicare Claims Processing Manual, sections 10.5 and 10.6.
Submitting electronic claims
Mailing paper claims
Priority Health Claims
P.O. Box 232
Grand Rapids, MI 49501