Responsibilities and standards news
Technical denials no longer apply to in-network providers' claims
We’re no longer applying technical denials to in-network provider claims.
July 7, 2025
IMRT to be added to post-pay audit program effective Aug. 23
Effective Aug. 23, 2025, intensity modulated radiation therapy (IMRT) will be added to the scope of our Post Payment Complex/Clinical Audit (PPCCA) program, supported by our vendor, Performant Recovery, Inc. (Performant).
July 7, 2025
You must complete our DSNP MOC training
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see PriorityMedicare patients are trained on our Model of Care.
June 30, 2025
Reminder to complete our D-SNP Model of Care training
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see PriorityMedicare patients are trained on our Model of Care.
June 30, 2025
November 2024 medical policy updates
Our Medical Advisory Committee (MAC), comprised of Priority Health network physicians, met in November and approved a series of medical policy updates.
June 30, 2025
August 2024 medical policy updates
Our Medical Advisory Committee (MAC), comprised of Priority Health network physicians, met in August and approved the following medical policy updates.
June 30, 2025
Complete our DSNP Model of Care Training
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see PriorityMedicare patients are trained on our Model of Care.
June 30, 2025
Reminder to complete our CMS-required D-SNP Model of Care training
All providers who are part of the Priority Health Medicare Advantage network need to complete training. This includes specialists, ancillary providers, or anyone part of an ICT (interdisciplinary care team) for a D-SNP member. This is a CMS requirement.
June 30, 2025
Unique NPI required for rehab groups to credential BH providers
We’re reminding all rehabilitation groups credentialed with us that, if they’d like to also provide behavioral health (BH) services, they’ll need to obtain a unique NPI specific to their BH services.
June 30, 2025
Mandatory pSA renewal reminder | Provider | Priority Health
Our annual prism Security Administrator (pSA) renewal period is underway. By August 1, pSAs need to review and either approve or deny all user affiliations for your group or facility so that they don’t lose access to essential data.
June 30, 2025
Reminder you must refer members to in-network providers including labs
Participating providers have a contractual obligation to use in-network providers when referring our members for services, regardless of your own contracts for referrals with non-participating labs.
June 30, 2025
Reminder of our technical denials policy
We'll begin applying technical denials to in-network providers' claims on Dec. 29, 2024.
June 30, 2025