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

ACNs can opt into our 2026 campaign to send at-home Cologuard test kits to targeted patients

Our 2026 campaign to help close care gaps in the Colorectal Cancer Screening (COL-E) HEDIS measure is open for Accountable Care Network (ACN) participation. 

What’s the campaign?

Each year, we partner with Exact Sciences to send at-home Cologuard^®   test kits to members who are eligible for inclusion in the COL-E measure and still need to complete a colorectal cancer screening in 2026.

Why it’s important

Our Exact Sciences campaign supports quality performance, contributes to better patient health outcomes and can improve provider performance in our PCP Incentive Program (PIP). 

Note: When a member completes and returns a single Cologuard test, it counts toward three years of gap closure in the HEDIS COL-E measure. 

How to participate

ACNs can enroll in our Exact Sciences campaign at any time by contacting their Provider Network Management (PNM) specialist. To allow members optimal time for test completion and processing, we ask that ACNs provide us with target lists by Aug. 1, 2026. Tests completed by members—and processed by Exact Sciences—by Dec. 31, 2026, will count toward 2026 gap closure for the COL-E measure

Register now for our April 30 Medicare & Medicaid quality webinar

Join us for a quality updates webinar on Thursday, April 30 at noon for information on:

• Medicare quality
• Medicaid quality

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. . 

Behavioral health providers contracted with Medicaid need to complete state-mandated trainings

Last year, the Michigan Department of Health and Human Services (MDHHS) announced the launch of the Michigan Medicaid “Mental Health Framework,” a new initiative to improve access to and the coordination of mental health care for Medicaid members in the state.

As part of the Mental Health Framework initiative, behavioral health providers contracted with Medicaid are required to complete assessment training for the Michigan Child and Adolescent Needs and Strengths (MichiCANS) Screener and the Level of Care Utilization System (LOCUS) as soon as possible. LEARN 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