All PlansAdministrativeHigh impact
Claim acknowledgement & status updates coming Sept. 1
Priority Health·Claims & Billing
Effective date
Sep 1, 2026
We identified it
Aug 4, 2026
Summary
Effective Sept. 1, 2026, Priority Health is retiring service receipts and transitioning claim processing to Epic. Billing teams will rely on 277CA (claim acknowledgement) responses instead. During the transition, claims with dates of service before Sept. 1 may receive two 277CA files (one from legacy system, one from Epic) and delayed 277 status responses, which should not trigger automatic resubmission. Claims with DOS on or after Sept. 1 will have normal processing.
Action Required
By Sept. 1, 2026: Billing team must (1) Update claim status tracking workflows to monitor for dual 277CA responses when a single 837 file contains both pre- and post-Sept. 1 claims—reconcile responses from both systems to avoid duplicate processing; (2) Modify claim follow-up procedures to recognize that A4:0 responses (Acknowledgement/Not Found) for pre-Sept. 1 DOS claims indicate delayed availability in the legacy system, NOT claim rejection—do not automatically resubmit these claims; (3) Implement a recheck process for A4:0 responses rather than automatic resubmission; (4) Update staff training on the Provider Portal transition and cessation of service receipt reliance. Failure to adjust workflows will result in duplicate follow-ups, unnecessary resubmissions, and confusion during the dual-processing period.