04/22/2020

Priority Health Update

Changes coming Jun. 15, 2020 to how we display corrected claims in your remittance advices

Based on your feedback and to better align with industry standards, we’re making changes to the way we display corrected claims in your remittance advices (RAs). We’re making this change to clearly distinguish between corrected claims and denials.

These changes will only impact provider-initiated claims reprocessing. Claims adjustments initiated by Priority Health will not be impacted.

Background
Currently, our standard paper remits and our electronic RAs (835s) include a voided claim record with a corrected claim. The voided claim record displays as $0.00 and is often misinterpreted as a denial. The voided claim record also displays a slightly different claim number than the original claim number, adding to the confusion.

Additionally, both types of RAs do not currently display the original claim number associated with the corrected claim on the corrected claim record, making it difficult to tie the corrected claim back to the original claim. We’ve heard you and are making changes effective Jun. 15, 2020 to our standard paper remits and 835s that address both areas of concern.

What’s changing: standard paper remits and electronic RAs (835s)

• Voided claim records will no longer be included, to help you clearly distinguish between corrected claims and denials
• The original claim number associated with the corrected claim will be included with the corrected claim record, making it easier to tie the corrected claim to the original claim

What’s not changing:

• Your time frame for receiving RAs will not change
• Claims adjustments initiated by Priority Health will not be impacted by these changes

COVID-19 update: Care management codes billable virtually, additional telemedicine clarification

Care management codes now billable using Place of Service 02

We know the importance of continuing to manage your patients’ health. To support you and ongoing care management, we’ve expanded your options to bill care management codes with a Place of Service 02.

Clarifying telemedicine billing and coding

We've extended the timeframe for our expanded coverage of telemedicine codes. Effective March 26 through June 30, 2020, we'll temporarily allow credentialed providers to bill routine practice codes with a Place of Service 02 and be paid the standard facility-based rate. The visit must follow the guidelines of each code, including the time requirements.

We're also allowing for real-time, interactive audio-only telehealth encounters, so you can serve your patients who don't have internet access or audio-visual capabilities.

COVID-19 update: Moving providers to different locations and credentialing new providers to support COVID-19 volumes

Moving providers to new locations

Participating providers can treat our members at different locations under the same tax ID.

If providers need to move between organizations with different tax IDs:

• For POs, PHOs and other large organizations, complete the COVID-19 Provider Move Spreadsheet and email it to PH-PELC@priorityhealth.com
• For individuals or small groups, complete our Provider Information Form and be sure to check "yes" on the COVID-19 question at the top

Credentialing providers

If you're a provider who needs to be credentialed with us to meet demands for capacity during COVID-19, complete our Provider Information Form and be sure to check "yes" on the COVID-19 question at the top.

For more information, see our Disaster Credentialing process within the Practitioner Credentialing Overview policy.

Special thanks to our 

Priority Health Managed Care Committee Member

Flora Varga

from

Cancer, Hematology & Rheumatology Centers of West Michigan