TRAINING OPPORTUNITIES
Register now to learn about our Jan. 1 formulary changes on Nov. 21
Join us for a webinar to learn more about upcoming formulary changes for all Priority Health plan types, as well as other pharmacy updates. This session will cover:
- 2025 commercial and individual formulary changes
- 2025 Medicare Part D formulary changes
- Impacts of the Inflation Reduction Act (IRA) in 2025
- An overview of the 2025 Medicare Prescription Payment Plan (M3P)
Can't join us?
All webinars are recorded and posted to our website within a week of the event, so you can watch at your convenience.
PRIORITY HEALTH
Don’t delay: Transition from APCD to PGE today
As a reminder, the transition from All Payer Claims Database (APCD) files to Provider Group Extract (PGE) files is underway.
If you haven’t yet made the transition to PGE, please do so before you lose access to the APCD files:
- Get set up to accept Secure File Transfer Protocol (SFTP) files from us, if you haven’t already.
- Update your mapping to the PGE before APCD files are fully retired.
We’ll continue to produce and deliver APCD files through the first quarter of 2025.
PGE files are now being delivered via SFTP on the 15th of each month to ACNs receiving APCD files. Note: We’re addressing a record truncation issue with the PGE files that we anticipate resolving with the November file run.
Updated PGE data dictionary now available
We recently made the following updates to the PGE data dictionary:
- Med Claim View tab: Now includes the previously missing field 101 – PROF_FAC_FLAG, which states whether the claim is professional (P) or facility (F)
- Member Elig View tabUpdated fields 54-56 to align the data dictionary with the raw file as follows:
New data dictionary name/element
Field Previous data dictionary name/element New data dictionary name/element
54 Provider group / PROV_GROUP PCP name / PCP_NAME
55 PCP name / PCP_NAME ACN PIP ID / ACN_PIP_ID
56 ACN ID / PIP_ACN_ID ACN Name / ACN_NAME
Get more information
For additional details, see our PGE FAQ.
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