Priority Health: New Clinical Edits Going into Effect on May 28, 2023

April 3, 2023

On May 28, we’ll implement the new clinical edits listed below and outlined in detail in the following documents:



Bookmark these links to always have the most updated clinical edit information.


Claim type 


Clinical edit 


Commercial, individual / ACA, Medicare 

Daratumumab Injection Code on Claim without Approved Indication

Bevacizumab and Biosimilars Billed without Approved Indication

Professional and Facility

All products

Ocrelizumab Injection Code Billed More Than Twice Per Month 


Additional information on our clinical edits policy is available online