Priority Health - Change to Referring/Ordering/ Attending Editing for Medicaid Claims

April 12, 2022

From Priority Health:

In accordance with the Michigan Department of Health and Human Services (MDHHS), we’ll reject claims when the referring, ordering or attending providers don’t align with bulletin MSA 21-45 for dates of service 1/1/2022 and after. 


How to make sure these claims are paid 

Make sure the National Provider Identifier (NPI) reported on the claim is of a provider type consistent with current licensing, scope of practice and Medicaid policy criteria. 


Reference these tip sheets when filing claims: 


We’ve posted a news item to our Provider Manual with more details.