Oakland Southfield Physicians

OSP News

New clinical Edits Are Going Into Effect for Priority Health

Posted: 06/06/2022

Priority Health values the care you provide their members and strive to reimburse you accurately and fairly for that care. Thoughtful implementation of clinical edits supports this goal, while allowing them to process your claims more efficiently.

During the third quarter of this year, they’ll implement the new clinical edits outlined below:

Online Digital E/M or Assessment Group Frequency
Online digital evaluation and management (E/M) services may be reported only once in a 7-day period by the same provider per CPT coding guidelines. Online digital evaluation and management (E/M) services reported more than once in a 7-day period by the same provider will be denied.

Ambulance Required Modifiers for Ambulance Service HCPCS Code Rule
Ambulance origin and destination modifiers should be appended to ambulance services. Ambulance codes that are missing origin and destination modifiers will be denied. Exception – an ambulance service will not be denied for missing origin and destination modifiers if modifier QL is appended to indicate the patient was pronounced dead after the ambulance was called.

Click here to read the full article on Priority Health’s website.

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