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General Billing Requirements & Claims Submission

PrimeWest Health providers (including billing organizations, intermediaries, and/or clearinghouses) must follow the PrimeWest Health billing policies.

Providers who render or supervise services are responsible for claims submitted to PrimeWest Health.

1. Submit claims only after you provide PrimeWest Health-covered services.
2. A claim cannot be submitted if a member doesn't show up for the appointment.
3. Bill only one calendar month of service per claim.
4. All claims require a valid diagnosis (ICD-9-CM) code.
   1. If there is not an appropriate diagnosis for the service you are providing, we request that you use the diagnosis code of V68.89. This diagnosis code simply states "Other specified administrative purpose."
5. Submit all claims electronically.
   1. All claims being submitted to PrimeWest Health by health care providers providing services for a fee in Minnesota must be transmitted electronically. PrimeWest Health offers two methods of free online direct claims submission through a web-based program: Infotech Global, Inc. (IGI)/MN E-connect (Registration Information) or Office Ally.
      1. These clearinghouses are available to submit claims electronically to PrimeWest Health.
      2. Follow HIPAA electronic data interchange (EDI) standards as outlined in the X12 or NCPDP
         Implementation Guides.
      3. Follow standards outlined in the Minnesota Uniform Companion Guides
      4. Use these file name conventions when submitting batch files.
   2. See Claims Submission on our website for additional details.