Priority Health: Update to Medicaid claims incorrectly being rejected in May 2023

June 5, 2023

Update June 2, 2023

The issue with Medicaid edit 5167 incorrectly front-end rejecting claims, first discovered on May 23, was resolved on May 30. All impacted claims have been reprocessed.

Original Noted posted May 26, 2023:

Priority Health is experiencing an issue with their Medicaid claims front-end rejecting for “Claim Type Requires a Referring/Ordering NPI” when they shouldn’t.  Priority Health teams are working to find the root cause and fix the issue as quickly as possible. Until then, they recommend you don't rebill those claims!

Their goal is to reprocess any impacted claims after the issue is resolved. If they are unable to reprocess claims, they’ll publish an update with next steps, and we'll put that update here in the NEWS section of the Lakeland Care website.

Priority values your partnership and the care you provide to our members, and they sincerely apologize for any inconvenience this has caused.  They appreciate your patience and understanding.