April 30, 2013: Attention ALL Providers: MDCH has identified manually priced claims or service lines that did not correctly report the Other Insurance information which resulted in overpaid claims. MDCH will be voiding these claims beginning on pay cycle 20 (May 16th, 2013) and providers will have the opportunity to rebill correctly reporting the Other Insurance information. Current Medicaid policy requires that all identifiable financial resources be utilized prior to expenditure of Medicaid funds for most health care services provided to Medicaid beneficiaries. Medicaid is considered the payer of last resort. The affected claims can be identified by reviewing the claim note within CHAMPS which will state "manually priced claim/lines bypassing OI".
Providers with further questions can contact provider support by phone# 1-800-292-2550 or by email: ProviderSupport@michigan.gov
April 29, 2013: Attention ALL Providers: MDCH will adjust incorrectly paid claims for voluntary sterilizations when the beneficiary was enrolled in the MOMS Benefit Plan. Voluntary sterilizations are not a benefit under the MOMS benefit plan. Current Medicaid Policy is outlined within the provider manual, Maternity Outpatient Medical Services Program Chapter, Section 2.2 NONCOVERED SERVICES. Providers with further questions can contact provider support by phone# 1-800-292-2550 or email: ProviderSupport@michigan.gov
April 22, 2013: Attention Professional Providers: MDCH has identified a high volume of claims that received overpayments as part of a CHAMPS defect which caused claims to pay above the billed amount. Current policy can be found within the Coordination of Benefits chapter, section 2.6.F. MEDICAID LIABILITY. These claims will be adjusted or voided by MDCH in the near future for proper adjudication.
April 16, 2013: Attention ALL Providers: The latest batch of MDCH Quarterly Newborn Recoveries is currently being processed. This batch includes fee for service claims for newborns that were retroactively enrolled into a Medicaid Health Plan. Please note, as with previous quarterly newborn take backs, claims must be submitted to the Medicaid Health Plans within 60 days from the Medicaid Remittance Advice date. Please review the following for information on how to verify the Adjustment Source of your claim. Providers with further questions can contact provider support by phone# 1-800-292-2550 or by email: ProviderSupport@michigan.gov
April 04, 2013: Attention ALL Providers: Due to CHAMPS server issues the archived documents function is currently unavailable. Providers can continue to check archived documents for documents such as Remittance Advices.
April 03, 2013: Attention ALL Providers: System maintenance for the DEG (Data Exchange Gateway) is scheduled for Sunday, April 21, 2013. The scheduled down time will be from 9:00 a.m. to 12:00 p.m. During this downtime please do not submit any files. We apologize for any inconvenience this causes your organization.
April 02, 2013: Attention OPH Providers: All claims paid with dates of service from 01/01/2013 through now will be adjusted with the newly loaded January APC updates and should start to appear on RA 04/04/2013. (Approximately 44,000 TCN's)
March 26, 2013: Attention Professional Providers: (Update to the Biller B Aware posting on February 5, 2013) Beginning on pay cycle 14 MDCH will start adjusting professional claims for dates of service on or after January 1, 2013 which were eligible for the Primary Care Rate Increase per MSA 12-66. Due to the volume of claims these adjustments will take place over multiple pay cycles. Providers with further questions can contact provider support by phone# 1-800-292-2550 or by email: ProviderSupport@michigan.gov
March 20, 2013: Attention DMEPOS Providers: Effective April 1, 2013, Health Care Procedure Codes (HCPCS) E2373, K0733 and L3600 fees will be reduced below Medicare fees to align with Medicaid policy referenced in the Medicaid Provider Manual, Medical Supplier Chapter, Section 1.7.H. A formal announcement of these changes will not be indicated in a policy bulletin. Please refer to policy and the Medical Supplier Database for standards of coverage and code parameters. The new reimbursement rates are as follows:
HCPCS Code: Rate Effective 04/01/13:
E2373 $560.10
K0733 $20.75
L3600 $52.43
March 13, 2013: Attention ALL Providers: System maintenance for the DEG (Data Exchange Gateway) is scheduled for Sunday, March 24, 2013. The scheduled down time will be from 10:00 a.m. to 2:00 p.m. During this downtime please do not submit any files. We apologize for any inconvenience this causes your organization.
March 11, 2013: Attention In-Hospital Providers: This serves as a reminder that per the Medicare Claims Processing Manual Chapter 3- Inpatient Hospital Billing Section 20.1 Hospital Operating Payments Under Prospective Payment System (PPS), any Medicare outlier payment due should be added to the Diagnosis Related Grouper (DRG)-adjusted base payment rate, plus any Disproportionate Share Hospital Payments (DSH), Indirect Medical Education (IME), and new technology add-on adjustments. This includes any Medicare Part A outlier payments received for a Medicare Part C covered service(s). CMS link: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c03.pdf
March 11, 2013: Attention Nursing Facility Providers, PACE and MI Choice Program Agencies: This is a reminder that the Michigan Medicaid Nursing Facility Level of Care Determination (LOCD) must be conducted only for "Medicaid eligible, Medicaid pending, and Dually eligible beneficiaries" regardless of primary payer source. The LOCD must be conducted within the time frames stated in Medicaid policy. Please note that failure to conduct the LOCD in accordance with Medicaid policy will result in the denial of a Medicaid claim. The LOCD policy is located in the Medicaid Provider Manual at
http://www.michigan.gov/mdch > Providers > Providers > Medicaid > Policy and Forms > The Medicaid Provider Manual
March 11, 2013: Attention ALL Providers: MDCH is announcing new Medicaid training sessions. Please review the website for a training near you: http://www.michigan.gov/mdch/0,1607,7-132-2945_42542_42543_42546_42552-127606--,00.html. Please note, additional trainings will be posted as they are scheduled. If you are unable to attend a session and would like assistance or training, please contact a MDCH provider consultant at: ProviderOutreach@michigan.gov to schedule a one-on-one appointment.
March 07, 2013: Attention In-Hospital Providers: This serves as a reminder that per the Medicare Claims Processing Manual Chapter 3- Inpatient Hospital Billing Section 20.1 Hospital Operating Payments Under Prospective Payment System (PPS), any Medicare outlier payment due should be added to the Diagnosis Related Grouper (DRG)-adjusted base payment rate, plus any Disproportionate Share Hospital Payments (DSH), Indirect Medical Education (IME), and new technology add-on adjustments. This includes any Medicare Part A outlier payments received for a Medicare Part C covered service(s). CMS link: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c03.pdf
March 06, 2013: Attention ALL Providers: MDCH would like to remind providers billing claims for Plan First beneficiaries that the diagnosis code reported as the primary diagnosis code must be within the V25 series. This is outlined within current policy in the Medicaid Provider Manual, Plan First! Family Planning Waiver chapter. As provider's bill on multiple claim forms MDCH encourages providers to review the billing guidelines for their specific claim type to find the appropriate field to report the primary diagnosis. Claims not billed with the Plan First qualifying diagnosis as the primary diagnosis will be denied. Providers with further questions can contact provider support by phone# 1-800-292-2550 or by email: ProviderSupport@michigan.gov
February 26, 2013: Attention ALL Providers: On February 23rd, Takeda and Affymax voluntarily recalled all lots of OMONTYS. In addition to the recall, they have instructed health care professionals that no new or existing patients should receive OMONTYS. Affymax and Takeda Announce a Nationwide Voluntary Recall of All Lots of OMONTYS ® (peginesatide) Injection. Notice to Health Care Providers FDA Press Release
February 26, 2013: Attention ALL Providers: MDCH has identified certain claims denied in error when billing for the copayment for a beneficiary with a private health plan insurance and the capitation amount was reported and considered as a payment. Per current policy outlined in the Medicaid Provider Manual, Beneficiary Eligibility Chapter 9.10.C. HEALTH PLAN AS A PRIVATE INSURANCE (OTHER INSURANCE CODE 89), the monthly capitation payment must not be reflected on the Medicaid claim. In most instances, the provider is billing Medicaid for the copayment amount only. Medicaid only reimburses the provider for the Medicaid fee screen or copayment amount, whichever is less. Providers are encouraged to resubmit or replace any claims previously billed incorrectly.
February 11, 2013: Attention ALL Providers: While doing an internal review of submitted claims, it has been identified that a high volume of claims are being submitted with Not Otherwise Specified (NOS) diagnosis codes. This serves as a reminder that all claims submitted to MDCH should be coded to the highest possible specificity based on the disease/condition/illness/injury for which the patient was seen.
February 05, 2013: Attention Professional Providers: MDCH has identified a problem paying the Primary Care Rate Increase as per MSA 12-66. A portion of this pricing was corrected within CHAMPS and claims should now correctly pay the rate increase for claims submitted after February 5th. Secondary claims eligible for the Primary Care Rate Increase will begin paying correctly after the next CHAMPS update, which is currently scheduled for February 22nd. After the update MDCH will adjust these claims on behalf of providers so claims eligible for the primary rate increase should then pay the additional amount. Providers with further questions can contact provider support by phone# 1-800-292-2550 or by email: ProviderSupport@michigan.gov
January 31, 2013: Attention Hospice Providers: MDCH has seen an increase in Hospice claims with the incorrect value code reported with the Core Based Statistical Area (CBSA) code. The reporting of the wrong value code can cause incorrect reimbursement. The National Uniform Billing Committee (NUBC) Manual states when reporting the CBSA code that Value Code of 61 must be reported. The billings instructions are contained in the National Uniform Billing Committee (NUBC) Manual as well as the Medicaid Provider Manual, Billing & Reimbursement for Institutional Providers, Section 11 - Hospice Claim Completion.
January 24, 2013: Attention ALL Providers: The latest batch of MDCH Quarterly Newborn Recoveries is currently being processed. This batch includes fee for service claims for newborns that were retroactively enrolled into a Medicaid Health Plan. Please note, as with previous quarterly newborn take backs, claims must be submitted to the Medicaid Health Plans within 60 days from the Medicaid Remittance Advice date. Please review the following for information on how to verify the Adjustment Source of your claim.
January 24, 2013: Attention Private Duty Nursing, Children's Waiver and SED Waiver: The previous posting dated January 14th has been resolved within the CHAMPS system. The affected claims have been identified and are in the process of being adjusted by MDCH to correct reimbursement of billing New Year's Day 2013. Providers with further questions can contact provider support by phone number 1-800-292-2550 or by email: ProviderSupport@michigan.gov
January 24, 2013: Attention Professional Providers: Per Bulletin MSA 12-42 Medicaid Enrollment of Physician Assistants and Nurse Practitioners; Billing Provider must be associated to both the Rendering and Supervising Provider in Champs for correct adjudication CLICK HERE for claim reporting Information
January 22, 2013: Attention ALL Providers: System maintenance for the DEG (Data Exchange Gateway) is scheduled for Saturday, February 2, 2013. The scheduled down time will be from 10:00 a.m. to noon. During this downtime please do not submit any files. We apologize for any inconvenience this causes your organization.
January 22, 2013: Attention ALL Providers: MDCH has developed an online DCH-0078 form to Add, Change or Terminate Other Insurance. The form can be found at: https://michigan.gov/mdch/0,4612,7-132-2943_4860-286772--SS,00.html In order for the form to be accepted the provider must fill out all of the required fields. This will remove the need to fax or email the completed DCH 0078 paper form.
January 17, 2013: Attention Outpatient Hospital Providers: MDCH has identified Outpatient Hospital secondary claims which were overpaid. MDCH has adjusted these claims and providers will begin seeing the adjustments starting on pay cycle number 4, dated 1/24/13, the Adjustment Source will be System Correction. Any further questions can be directed to Provider Support by phone 1-800-292-2550 or by email ProviderSupport@michigan.gov
January 14, 2013: Attention Private Duty Nursing, Childrens Waiver and SED Waiver: MDCH has identified a problem paying holiday rate for New Year's Day. MDCH is currently working on identifying and resolving this issue, once further information is available there will be a message posted.
|
