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 Product Clinical edit Professional Commercial, individual / ACA, Medicare Daratumumab Injection Code on Claim without Approved IndicationBevacizumab and Biosimilars Billed without Approved IndicationProfessional and FacilityAll productsOcrelizumab Injection Code Billed More Than Twice Per Month 

 Additional information on our clinical edits policy is available online