Billing Policy Updated

We publish billing policies March 2026 billing policy updates 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.

Note: If the effective date is listed as N/A, the policy represents our current system set up and/or expectations for transparency. There are either no changes for you as the policy is already in effect or was recently shared with the network and we’re implementing a clinical edit in alignment with the policy’s language.

Billing Policies page

New MOON form for hospitals and critical access hospitals now available

There’s a new Medicare Outpatient Observation Notice (MOON) form available, which hospitals and critical access hospitals (CAH) are required to use beginning Apr. 20, 2026.  CLICK HERE

As a reminder, hospitals and CAHs must give the standardized MOON form to individuals receiving observation services as outpatients for more than 24 hours. The form explains the individual’s status as an outpatient (rather than inpatient) and the implications that an outpatient status has for Medicare cost sharing and coverage for post-hospitalization skilled nursing facility (SNF) services. 

Access the form: 

• MOON form – English
• MOON form – Spanish 
• Large print options via CMS

Reminder: Providers in Priority Health’s PPO network should see all group commercial members with Cigna Healthcare and their affiliates

Through our Strategic Alliance with Cigna Healthcare, members with any employer health plan through Cigna and their affiliates are in network with Priority Health PPO providers. These members should be considered in network even if “Open Access Plus” or “OAP” does not appear on their member ID cards.   READ MORE

Included plans

All Cigna group commercial members have access to the Priority Health PPO network in Michigan. These Cigna plan types include:

• Open Access Plus^® (OAP)
• PPO
• LocalPlus^® (Members have access when traveling in Michigan.)
• Network/POS/HMO (Members residing in Michigan or Ohio have access; all others have urgent/emergent care only.)

Members with group commercial coverage through Cigna’s other Strategic Alliance partners are also included. Common affiliates you may see include Medical Mutual of Ohio (MMO), HealthPartners, MVP Health Care and the NALC Health Benefit Plan.

Excluded plans

The following plans do not have access to Priority Health networks:

• Individual Family Plans (IFPs) through Cigna and affiliates
• Cigna ACA Marketplace plans through Cigna and affiliates
• Medicare plans through Cigna and affiliates
• SureFit^®

ID cards

Cigna and Cigna-affiliated members may have the Priority Health logo on their card, depending on if they live in Michigan. However, members with qualifying plans should be seen regardless of whether the Priority Health logo appears on the card. Look for the Cigna logo in addition to one of the products that have access noted above.      

Additional information

Learn more about the Priority Health + Cigna Strategic Alliance on our Provider Manual.

Register now for our March 26 behavioral health billing & coding webinar

Join us for a behavioral health billing & coding webinar on Thursday, March 26 at noon for tips and updates on:

• Coding for Risk Adjustment in behavioral health
• Behavioral health Collaborative Care codes
• Behavioral health billing & coding
• Telehealth coding with Behavioral Health
• Coding for gap closure in the Initiation and Engagement of Substance Use Disorder Treatment (IET) HEDIS measure

How to register

You can join us by registering online. 

Can’t join us?

All webinars are recorded and posted to our provider webinars page within a week of the event, so you can watch at your convenience. 

Update: EOBs no longer accepted through prism inquiries for claim reprocessing

What’s happening 

Today, when a claim denies for needing another insurance carrier’s payment information (EOB), we’re receiving the EOBs through a prism inquiry, asking for the claim to be reprocessed.   

What’s changing

Effective May 5, 2026, we'll no longer accept an EOB attached to a prism inquiry for claim adjustment. If a claim is denied for needing the other payer’s information, providers must resubmit the claim electronically with the other insurance payment information included.

What this means for providers

When submitting claims electronically, be sure to include any other payer payment information to ensure proper reimbursement. Please be sure to update your internal billing processes to ensure all claims include this information. 

READ MORE

Introducing the 2026 Provider Mini-Grants Pilot Program

To support quality care and the hard work our providers put into caring for our members, we’re launching the 2026 Provider Mini-Grants Pilot Program. This program offers grants of up to $10,000 to provider-led projects that are working to make care better or more accessible for our members. 

What are the guidelines?

To be eligible for this program, providers must be part of the Priority Health network and practice in the state of Michigan. Projects should support Priority Health member care and be completed by Dec. 31, 2026. Providers selected for the program will be required to provide a report summarizing their project results by Jan. 31, 2027.

Learn more about this opportunity HERE