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11/03/2021
Priority Health Update
Priority Health Managed Care Committee Member
Flora Varga, Cancer & Hematology Centers of West Michigan
Attention MSHO Members: (Note from Flora Varga)
Anyone receiving denials on the following lab panel codes 80053, 85025 & 84443?
These charges were billed without code 80050. These lab panel codes have been getting paid until recently.
Priority Health Medicare will have an answer as soon as possible.
UPDATE 11/2/2021:
There was an error in the PH editing system for MCD and the MCR products denying the 80053 lab codes. Leaving us to wonder if they wanted the lab panel code billed. We were informed this has been corrected in their system effective 10/26 and they are reprocessing claims.
Changes to COVID-19 vaccine and lab testing billing coming Jan. 1, 2022
On Jan. 1, 2022, changes to how the COVID-19 vaccine and lab testing services are covered will go into effect.
What’s changing?
We’ll start paying for Medicare members’ vaccines
On January 1, you should begin billing us for the COVID-19 vaccine and its administration for all Medicare members enrolled in our plan. We’ll post the appropriate CPT codes in our Medicare fee schedules (login required). READ MORE
Improving provider credentialing and change requests turnaround times
We’re working to fix our delayed processing times on your provider enrollment and change requests.
We know we’re not meeting your expectations or ours right now. We recognize how challenging this is for your practices and the impact these delays have on accurate claims and incentive program payments. We’re committed to improving turnaround times with our backlog resolved by the first quarter of 2022. READ MORE
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