July 2026 billing policy updates
We publish billing policies to offer transparency and help you bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information. To view billing policies CLICK HERE
Simplified Process for Submitting Level 1 and 2 Claim Disputes
Effective Aug. 1, 2026, we’ve simplified our claim dispute process by removing the requirement to attach applicable Priority Health billing and coding policies and/or medical policies when submitting a Level 1 and Level 2 claim dispute.
Providers are still required to submit a complete rationale and all supporting documentation necessary for review. For an overview of the updated process CLICK HERE
We're Encouraging Select Members Receiving Prolia® or Xgeva® to Discuss Covered Biosimilars With Their Providers
As part of our ongoing efforts to help keep medications affordable while maintaining quality care, we’re reaching out to select Medicare members currently prescribed Prolia® or Xgeva® to encourage discussions with their providers about transitioning to a covered biosimilar. READ MORE
Reimbursement is Available for Medicaid Mental Health Screening Assessments, Including Those Conducted via Telehealth
As a reminder, eligible providers are reimbursed when they complete the required Level of Care Utilization System (LOCUS) and Michigan Child and Adolescent Needs and Strengths (MichiCANS) mental health screening assessments for Priority Health Medicaid members.
These assessments may be conducted in person or via telehealth, when clinically appropriate and consistent with applicable MichiCANS requirements. READ MORE
Claim Acknowledgement & Status Updates Starting Sept. 1
In alignment with the launch of our new Provider Portal, service receipts will be retired. Look to your 277CA (claim acknowledgement) response instead, including details on any claims rejected up front for invalid or missing data elements.
Additionally, while we transition claim processing operations to Epic starting Sept. 1, your experience with 277CA and 277 (claim status responses) may be temporarily different. READ MORE
Get ready: Steps to Take Now For Our New Provider Portal
The new Provider Portal for Priority Health is going live on September 1, and registration is now open for all users. If you haven’t requested an account yet, please go to our onboarding page to get started.
Our current portal, prism, will be retired the day the new Provider Portal goes live. Beginning September 1, you will not be able to log in to prism or see anything on your prism account.
To retain visibility into all pending activity, we recommend holding all non-urgent requests beginning in mid-August until the new portal goes live on September 1. READ MORE
Register now for our new Provider Portal training webinars HERE
HIDE-SNP Members May Qualify for LTSS
Patients enrolled in Priority Health’s Highly Integrated Dual Eligible Special Needs Plan (HIDE-SNP) plan may qualify for Long-Term Services and Supports (LTSS) to help them safely receive care at home or in community or facility settings. READ MORE