Priority Health - Changes to Medicaid Billing Requirements start December 14, 2020

December 14, 2020

To remain in compliance with Medicaid billing requirements, on December 14, we’re moving to up-front claims rejections that have the missing or incorrect information listed below. Previously these were warnings.


What’s changing

The new upfront rejections included:

  • Claim Type Requires a Referring/Ordering NPI
  • Provider Type Not Allowed for Referring/Ordering/Attending NPI
  • Claim Not Covered When Referring/Ordering/Attending is Chiropractor
  • Referring/Ordering/Attending is not Enrollment Type 1/Individual

In addition, all claims must be submitted in the appropriate format or they will also receive an up-front rejection.