All PlansAdministrativeMedium impact
We've simplified our process for submitting Level 1 and 2 claim disputes
Priority Health·Claims & Billing
Effective date
Aug 1, 2026
We identified it
Aug 13, 2026
Summary
Effective August 1, 2026, Priority Health has simplified the Level 1 and Level 2 claim dispute submission process by removing the requirement to attach Priority Health billing and coding policies or medical policies. Providers must still submit complete rationale, supporting documentation, and reference applicable policies, but no longer need to physically attach Priority Health policy documents. This streamlines the dispute workflow while maintaining review standards.
Action Required
By August 1, 2026: Billing team must update claim dispute submission procedures for Priority Health Level 1 and Level 2 disputes. Remove the step of attaching Priority Health billing/medical policy documents from dispute packets. Ensure team continues to include: (1) complete rationale for each dispute, (2) specific disputed codes, (3) reference to applicable Priority Health policies with specific section citations, and (4) supporting documentation (regulatory guidance, non-Priority Health guidelines, contract language, fee schedules). Update internal dispute submission checklist and train billing staff on the revised process. Reference Priority Health's Level 1 Claim Disputes webpage and Claim Dispute Process section for current guidance.