HIDE-SNP nursing facility claim submission reminder

This is a reminder for nursing facilities submitting claims for PriorityMedicare Dual Premier (HIDE-SNP) members. 

We recently updated our claims processing systems to align with existing MDHHS requirements. To help prevent claim denials, corrections and resubmissions, we recommend you review and follow the nursing facility billing requirements found in the Medicaid Provider Manual. 

Section 8 of the chapter titled “Billing & Reimbursement For Institutional Providers” includes guidance on: 

• Patient-Pay Amount
• One Facility – Two Claims in One Month
• Two Facilities – Two claims in One Month
• Offset to Patient Pay Amount for Non-covered Services
• Claim Documentation Requirements when Offsetting the Patient Pay Amount 

Please confirm that claims for PriorityMedicare Dual Premier members follow these requirements before submission. Claims submitted incorrectly may deny and require correction and resubmission.

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New “Coding Connections” resource to help prevent unnecessary claim denials

Accurate coding and complete documentation can help prevent unnecessary claim denials. With this in mind and to better support you, our provider network, we’re introducing Coding Connections – a new monthly resource filled with practical billing and coding tips based on common claim denials and questions we often receive. 

 With each edition, we aim to: 

• Identify and offer advice on how to avoid common coding errors
• Support accurate claim submission
• Reduce avoidable denials and appeals
• Reinforce Priority Health-specific billing and coding requirements

This month marks our first edition. Please share this resource with your billing, coding and other team members involved in claim submission. And watch for additional Coding Connections tips each month. 

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New Medicaid-only credentialing form now available

Starting Oct. 1, 2026, new individual providers enrolling with Priority Health for Medicaid only will use a new standardized credentialing and enrollment form. This change is in alignment with the Michigan Department of Health and Human Services (MDHHS) new requirements for Michigan’s Medicaid Health Plans (MHPs). READ MORE 

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Reminder: Do NOT collect upfront deductible or coinsurance payments from PriorityHRA members

Priority Health plans may include a health reimbursement arrangement (HRA). Providers should not collect estimated deductible or coinsurance payments from Priority Health members with an HRA in advance of billing Priority Health. Instead, collect any required copays at the time of service   and submit claims for other costs of care to Priority Health first. Priority Health will pay providers directly from the member's HRA for eligible expenses. READ MORE

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October 2026 billing policy updates

We publish billing policies to offer transparency and help providers to bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.  READ MORE

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National Prescription Drug Take Back Day coming Oct. 24

We’re pleased to participate again in National Prescription Drug Take Back Day on Saturday, Oct. 24, 2026. We invite your patients and all community members to drop off their expired, unwanted or unneeded prescription medications for safe disposal from 10 a.m. – 2 p.m. at Priority Health, 3111 Leonard St. NE, Grand Rapids.  

We'll also distribute free Narcan, a fast-acting medication that can reverse opioid overdose, again this year.  

If this site is not convenient, look for a collection site near you.  

Please join us in educating community members about the importance of properly disposing of unused or expired medications to help reduce substance use. 

Have patients with substance use conditions? Contact our care coordination team  

Our behavioral health department has clinical staff who specialize in helping members manage complex and chronic mental health and substance use conditions. Our care coordination team is available to support you as you help your patients get the outpatient care they need or successfully transition from a hospital setting back into the community. 

Encourage your patients to try Teladoc Health Mental Health Teladoc Health Mental Health is a digital tool that offers over 1,400 self-directed activities on a variety of mental wellness topics including alcohol and drug recovery as well as opioid recovery. These tools are available to our members 24/7 and complement the care you provide them to create real, lasting change. Encourage your patients to sign up for a free account today.