Medicaid Alerts


Description: Description: Biller B Aware

Description: Description: Provider Tips

Description: Description: Medicaid Providers

Description: Description: Provider Manual

Description: Description: Provider Fee Schedule

Description: Description: Forms

 Description: Description: CHAMPS

Description: Description: Policy Bulletins

Description: Description: ICD10

Description: Description: Email Provider Support

 

Description: Description: Phone Menu for Provider Support


Description: Description: Biller B Aware

 

July 27, 2016: Attention All Providers: MDHHS now receives weekly files from BCBSM and BCN. All Policy Changes (adds, terminations and other changes) are reported on the file. Therefore, in most cases you will not need to notify TPL of a Policy Change. However, please report Policy Changes that occur:

  • within the last 30 days if there are access to care issues
  • more than 30 days ago

Please Note:

·        Changes reported to http://www.michigan.gov/reportTPL with an email address will receive an email confirmation when TPL completes the review.

·     If a change is not made, your Blue Cross provider consultant can ensure that the coverage on web-DENIS is correct and can help get BCBSM and BCN records updated when necessary.

·         TPL may close the request due to a system (file) update made after the request was received. If your confirmation states that the system has been updated and you feel a change is still needed, please report the change again.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov.

July 27, 2016: Attention Nursing Facility Providers: MDHHS is aware of delays in updating Provider IDs and Level of Care (LOC).  We are currently working on addressing the issue to expedite these updates. Thank you for your patience.

July 25, 2016: Attention All Providers: Children’s Special Health Care Services (CSHCS) will be migrating from the Covisint Provider Link (EZ Link) to the CHAMPS Document Management Portal (DMP) effective August 1, 2016. Electronic document submissions for eligibility, renewal, and provider additions for CSHCS clients will only be received through DMP beginning August 1, 2016.
 
Providers with further questions may contact Kristie Ferris at 517-241-9702 or FerrisK1@michigan.gov for assistance.

July 20, 2016: Attention All Providers: This is an update to the message posted on July 19, 2016 regarding Document Management Portal (DMP) and the messaging function for claims suspending for Predictive Modeling. This messaging function is only available for medical documentation submitted via the DMP or FAX. This function is not available for medical documentation submitted via mail.

July 19, 2016: Attention All Providers: Beginning July 22, 2016, the messaging function within the Document Management Portal (DMP) will be available for claims suspending for Predictive Modeling. This messaging function will allow providers and MDHHS staff the ability to communicate when it is determined that certain documentation is missing or not legible after an initial review of submitted documentation has been completed. This messaging function does not replace the initial documentation request letter that providers receive when the claim initially suspends for Predictive Modeling.

MDHHS will send a message to the provider indicating which document (s) is needed and the provider will have 10 business days to upload additional requested documentation and respond back to MDHHS via DMP messaging.

There are two ways to access messages within DMP:

1: Message Tab within DMP:

champs messages

 

 

 



2: Message Icon within search messages:

champs message icon

 

 

When a new message is available in DMP, an email will be sent to the provider’s email associated to the MiLogin account that was created when you signed up for CHAMPS. 

For detailed instructions for this messaging function, click on DMP/Messaging.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov.
 

July 19, 2016: System Outage: Due to CHAMPS Emergency Release deployment, the CHAMPS system will be down between 7:00 PM Friday, July 22nd 2016 and 2:00 AM Saturday, July 23rd 2016. This outage will affect the system access for all functionality. We apologize for any inconvenience this may cause.

July 12, 2016: Attention Professional Providers: This is an update to the June 14, 2016 message related to the MUE on Subsequent Hospital Care 99231-99233 updated to reflect 1 visit per day per same rendering/servicing provider. The affected claims from DOS 10/1/2015 forward will be recycled and the recycled claims will appear on a future remittance advice. Claim adjustments on incorrectly paid claims may also be initiated by the provider.

Initial Hospital Care 99218-99223 will remain one visit per day per same group/billing provider.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov.

July 11, 2016: Attention ALL Providers: The latest batch of MDHHS Quarterly Newborn Recoveries is currently being processed. This batch includes Medicaid 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.

July 07, 2016: Attention Outpatient Hospital Providers: This is an update to the messages posted June 28, 2016 and April 7, 2016, related to APC/OPPS quarterly software updates. Claims with dates of service on and after January 1, 2016-March 31, 2016 billed with codes G0477-G0483 may have incorrectly paid zero dollars. The codes rates will be updated in the July 2016 quarterly APC/OPPS software updates which will be completed on September 30, 2016. MDHHS will adjust any paid claims that were affected. We apologize for any inconvenience

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov

July 07, 2016:  Attention Trading Partners:  Electronic claim submission files submitted in June 2016 may have been accepted and a 999 acknowledgement was returned through the File Transfer Service (FTS) connection. The 999 acknowledgements were not stored in Champs and the file was not loaded through claims adjudication. The missing 999s have been re-loaded by MDHHS and files are now in claim adjudication process and will appear on a future remittance advice. Trading Partners may see two duplicate 999 acknowledgement files if they retrieved them through the FTS connection. Any Affected Trading partners will be contacted via e-mail by MDHHS.

If you have further questions please contact AutomatedBilling@michigan.gov

July 06, 2016: Attention ALL Providers: MDHHS is offering a CHAMPS Document Management Portal (DMP) virtual training on July 21, 2016 from 10:00-11:00 AM. This tool enables Providers to electronically submit supporting documentation for Medicaid claims filed electronically through CHAMPS, submit consent forms, and submit records requested for Predictive Modeling requirements. This training will present important topics and updates, including:

  • What is DMP?
  • Accessing DMP
  • Searching for Documents in DMP
  • Uploading Documents
  • Faxing Documents
  • Beginning July 22, 2016, MDHHS use of the messaging function to providers to communicate requests for additional documentation on claims suspending for Predictive Modeling. 
  • Provider Resources

Please visit our Medicaid Provider Training page to register.

July 05, 2016: Attention ALL Providers: As part of the most recent update within CHAMPS, providers will now see a change in how claim adjustment reason code (CARC) 23 is reported on the 835/Electronic Remittance Advice (ERA). Claims will be impacted by prior payer’s adjudication, including prior payment and/or adjustments, which are contractual CARC amounts and will be reported back to providers as CARC 23.  Any Medicaid liability CARCs will be reported back to providers in CARC 45. 

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov. 

July 01, 2016: System Outage: Due to CHAMPS release deployment, the CHAMPS system will be down between 6:00 PM Saturday, July 9th 2016 through 6:00 AM Sunday, July 10th 2016. This outage will affect the system access for all functionality. We apologize for any inconvenience this may cause.

June 29, 2016: Attention ALL Providers and Trading Partners: CHAMPS has been updated to EDIFECS version 8.6.2 as part of the most recent CHAMPS system update, 6/24/16.  A number of 837 and or 835 edits have been updated, added, or deleted since this last upgrade. For reject edits that may have a significant impact on Fee for Service (FFS) submission, MDHHS is delaying turning the disposition to reject until the end of August 2016 (60 days after 6/24/2016).

The edits are as follows:

  • Description is required for NOC procedure code
  • Updated edit for validation of Canadian zip code (N403) to allow value of 6 characters only.
  • Added new edit for N404 Country Code not to be one of US territories.
  • Added new edit for ICD-10-CM Primary/Principal diagnosis: it cannot be External Cause code.
  • Added new edit allowing to send K3 segment with original NDC code.
  • Added new edit restricting usage of UB-04 "Payer-Only" codes. These codes are reserved for payer internal use only and should not be used on a claim. "Payer-Only: codes for NUBC UB-04 ECLs are:
    - 132 Condition: 12-16, 62-65, M0-M9, MA-MZ, UU;
    - 132 Occurrence: 23, 48-49;
    - 132 Occurrence Span: 79;
    - 132 Value: 17-20, 62-65, 70-79, Q0-Q9.
  • Updated edit restricting usage of External Cause ICD-10-CM diagnosis codes as primary/principal diagnosis
    from codes starting from "V0" and codes having V-Y to codes starting from V-Y.
  • Added new edit restricting usage of ICD-10 codes for the purpose of External Cause of Injury.
  • Updated edit to provide infrastructure to specify the list CARCs that may be used more than once. The list of such CARCs can be edited in User Global Declaration.
  • Updated edit to restrict usage of duplicate CARCs within claim/service line.
  • New edit for zip plus four zip codes cannot end in four “0”s or four “9”s
  • Updated function for the date format
  • New edit to restrict ST02 value format to numeric character (on 835).

Please review your audit files with extra scrutiny to ensure that you have accounted for these new edits prior to the status changing to reject. If one of these edits sets after they are turned to reject, your entire file will be rejected in only one transaction.  If multiple transactions within the file are rejected then only that transaction will be rejected and not loaded.

Please contact AutomatedBilling@michigan.gov with any further questions.

June 28, 2016: Attention Outpatient Hospital Providers: This is an update to the message posted April 7th, 2016 and May 04, 2016, related to APC/OPPS quarterly software updates. Claims with dates of service on and after January 1, 2016 through March 31, 2016, billed with codes G0477-G0483, may be paying at zero dollars. Claims with dates of service on or after April 1, 2016, billed with these codes are paying appropriately. MDHHS will notify providers with an update as soon as the rates records issue is resolved.

Providers with further questions can contact Provider Support by email at ProviderSupport@michigan.gov. Please include in the subject area: Attention OPPS Claim Question.

June 23, 2016: Attention Providers: Beginning June 27th MILogin will be replacing Single Sign-On.

If you are a current SSO user, you will use your same User ID and Password to access MILogin.  DO NOT register as a new user.

You will access CHAMPS through MILogin at: https://milogintp.michigan.gov

There will not be any changes within CHAMPS, just a new portal to access it. If you login through Single-Sign on (SSO) on or after June 27th 2016, you will not see CHAMPS on your list of applications, just the link through MILogin. You may want to bookmark the MILogin link in preparation for this change.

Further information that explains this change can be accessed on the MILogin informational site.

June 23, 2016: Attention ALL Providers: This is an update to the message posted August 27, 2015 related to systems issues that caused some beneficiaries to not receive timely Medicaid coverage. Guidance on how affected beneficiaries and providers could obtain appropriate reimbursement was provided. Providers who had claims denied for eligibility edits for Medicaid beneficiaries in the groups as outlined in L-letter 15-48 were directed to resubmit those claims for consideration by March 31, 2016.

MDHHS has experienced some delays in the processing and letter notification to individuals and families who were eligible for Transitional Medical Assistance (TMA) and Special N Support (SNS) from March 2014 through March 2015.  Providers have up to 6 months from the beneficiary deadline date listed on the beneficiary notice to submit claims.  Claims with dates of service greater than 12 months from the date of submission need to have “MAGI Corrective Action” reported in the claim notes section (HIPAA transaction NTE segment Loop 300) in order for the claim to process correctly.

MDHHS also asks providers for patience when taking action against those beneficiaries with an outstanding balance, and encourages providers to delay initiation of any collections proceedings until affected claims are submitted and reprocessed.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov.

June 20, 2016: System Outage: Due to a CHAMPS Release deployment, the CHAMPS system will be down between 7:00 PM Friday, June 24th, 2016 and 2:00 AM Saturday, June 25th,  2016. This outage will affect the system access for all functionality. We apologize for any inconvenience this may cause.

June 16, 2016:  Attention Inpatient Hospital Providers:  MDHHS is receiving multiple inquiries regarding authorization guidelines for care in a Long-Term Acute Care Hospital (LTACH).   Bulletin MSA 15-30 addressed the reimbursement methodology changes made by the Hospital Reimbursement Reform Initiative (HRRI) Technical Workgroup.  There were no changes nor was there any intent to change authorization/PACER requirements.  All inpatient hospital services require authorization.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov.

June 14, 2016: Attention Professional Providers: The MUE on Initial and Subsequent Hospital Care, Procedure Codes 99218-99233, have recently been updated and limited to reflect 1 visit per day per same group/billing provider. These claims will deny with CARC 18, 119. This service is “per day”, as such, all visits from the same group would be encompassed into the payment regardless of the number of times the patient was seen on that day.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov.

June 09, 2016: Attention ALL Providers: Beginning June 12, 2016 the passwords for user login for Web page (HTTPS Internet Connection) for the File Transfer Service (FTS) will become case sensitive. Currently, if your password is working on the FTS there is nothing you need to change. If you are prompted to change your password, please refer to the Electronic Submissions Manual. 

Please contact AutomatedBilling@michigan.gov with questions.

June 07, 2016: System Outage:  Due to system maintenance, the CHAMPS system will be down between 6:00 PM Saturday, June 11th, 2016 through 9:00 AM Sunday, June 12th, 2016. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

June 03, 2016: Attention ALL Providers: June 2016 is ‘Alzheimer’s Awareness Month’ in Michigan and the state is going “Purple!" to raise awareness of this effort. As part of this effort various screens and text within CHAMPS will appear purple, instead of the normal blue.

Those seeking more information about Alzheimer's disease and the free support and services the Alzheimer's Association offers are encouraged to call the 24/7 helpline at 800-272-3900 or visit http://www.alz.org to find out how to contact the Chapter that serves their community.

 

June 02, 2016: Attention ALL Providers: Beginning June 27th MILogin will be replacing Single Sign-On.

You will access CHAMPS through MILogin at:

There will not be any changes within CHAMPS, just a new portal to access it. If you login through Single-Sign on (SSO) on or after June 27th 2016, you will not see CHAMPS on your list of applications, just the link through MILogin. You may want to bookmark the MILogin link in preparation for this change. 

Further information that explains this change can be accessed on the MILogin informational site.

May 25, 2016: Attention ALL Providers: Blue Cross Blue Shield of Michigan (BCBSM) has recently begun sending Third Party Liability (TPL) voided coverage to remove coverage which had previously loaded and was later identified as invalid. TPL has made efforts to identify any voids that have been missed; those records were removed in April and May. Beginning in June 2016, BCBSM will be sending all necessary coverage records, including adds, terms, updates and voids.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov.

May 25, 2016: Attention ALL Providers: This is an update to the message posted on May 24, 2016 related to timeout issues with Core 270/271 Real-time Eligibility transactions. These issues have now been resolved. MDHHS will continue to monitor the system. We apologize for any inconvenience.

Please contact AutomatedBilling@michigan.gov with any further questions.

May 24, 2016:   Attention ALL Providers: CHAMPS Real-time 270/271 Eligibility transactions are experiencing network connectivity issues. MDHHS is working to analyze this issue and will continue to monitor the system. We apologize for any inconvenience.

Please contact Automatedbilling@michigan.gov with any further questions.

May 24, 2016: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) has recently updated the Predictive Modeling FAQ resource document on the provider website. 

Providers with further questions can contact Provider Support by email at ProviderSupport@michigan.gov. Please include in the subject area: Predictive Modeling. 

May 16, 2016: Attention ALL Providers: On June 12, 2016 the passwords for user login for Web page (HTTPS Internet Connection) for the File Transfer Service (FTS) will become case sensitive. Currently if your password is working on the FTS there is nothing you need to change. If you are prompted to change your password please refer to the Electronic Submissions Manual.

Please contact AutomatedBilling@michigan.gov with questions.

May 09, 2016: System Outage: Due to system maintenance, the CHAMPS system will be down Saturday, May 14, 2016 6:00 PM EST through Sunday May 15, 2016 6:00 AM EST. This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

May 09, 2016: Attention Outpatient Hospital Providers: All Outpatient Hospital claims with dates of service on or after 1/01/2016 will be adjusted or resurrected to process using the newly loaded January APC software updates and will begin to appear on pay cycle 18  (4-28-2016 Remittance Advice (RA)). Adjusted claims can be identified by the claim note “APC Jan 2016 quarterly updates.”

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov.

May 09, 2016: Attention ALL Providers: A new ICD-10 Resource Tool, "ICD-10 Code Lookup,” has been posted to the Michigan Department Health and Human Services (MDHHS) ICD-10  Webpage. This helpful conversion tool provides quick access to frequently used codes. Please note that this tool should be not used as a final mapping for ICD-10 Codes and all codes should be verified via Centers for Medicare and Medicaid Services (CMS).

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or by email ProviderSupport@michigan.gov

 
 2015

 2014

 2013

 

2010 2011 2012 BBA

 

 Provider Tips

 

Description: All Providers

Description: Description: Ambulance

Description: Description: Clinics

Description: Description: Dental

Description: Description: Hospice

Description: Description: Hospital

Description: Description: Nursing Facility

Description: Description: Pharmacy and DME

Description: Description: Physician

 Professional

 

 


All Providers

July 19, 2016: Documental Management Portal (DMP) Messaging Function for Predictive Modeling

April 21, 2016: Hearing Providers: Audiologists individual NPI must be associated to a Hearing Aid Dealer or Hearing Center billing NPI; for claim adjudication.

March 02, 2016: Billing Newborn Services when mother is enrolled in a Medicaid Health Plan (MHP)

If the mother is enrolled in a Medicaid Health Plan (MHP) at the time of delivery, the newborn's services are also the responsibility of the MHP unless the child is placed in foster care. Providers are encouraged to review MSA L-Letter 15-66 for current policy information. Providers are advised to validate the mother's enrollment in a MHP when rendering services for newborns to ensure services are billed appropriately to the correct payer. All newborn charges must be billed to the MHP using the newborn’s ID.

June 04, 2015: How to use the CHAMPS Claim Limit List

May 04, 2015: CHAMPS Navigation 

April 08, 2015: CSHCS Provider Information Page

March 19, 2015: ICD-10 Virtual Presentation

 

March 10, 2015: How to Adjust a claim with OTHER INSURANCE

March 10, 2015: Refund of Payment
 

March 10, 2015: Benefits Monitoring Program (BMP):

Benefits Monitoring Program

Verifying BMP Eligibility

Beneficiary Notification Letter Example

Beneficiary Final Notification Letter Example

 

MSA 1302 for Specialty Referrals

Click here for archived Provider Tips and Presentations


 

Ambulance

 

April 20, 2016: Billing two Separate Runs on the same DOS

 

March 24, 2016: Tips for Requesting Prior Authorization

 

March 24, 2016: Non-emergent Ambulance Services Denials on Medicare Primary Crossover Claims:       

Providers are encouraged to report the referring physician field when sending claims to Medicare in order to avoid claim denials with CARC 208, N286, and N290 on the crossover claim. Medicaid requires an enrolled ordering/referring/attending physician to be on all non-emergent ambulance services billed. For professional ambulance claims, this is Loop 2310A or 2420F (Referring) or Loop 2420E (Ordering). For institutional claims, this is Loop 2310A (Attending) or Loop 2310F or 2420D (Referring).


 

Clinics

 

March 23, 2016: Billing Tips-Vaccine for Children (VFC)


February 24, 2015: Clinic Billing Tips 


 

Dental

 

April 26, 2016: Verifying Dental Eligibility: For beneficiaries that are Medicare eligible and are not Medicare enrolled, the other insurance field will appear with Medicare and all 11111111 or 22222222. Even though Medicare does not pay for dental services, beneficiaries must obtain Medicare before the system can process and by-pass dental claims. The only exception is if the beneficiary is an alien and has not been in this country for 5 years. The date and port of entry must be reflected in the claim remarks. 

January 29, 2016: Claims being submitted for beneficiaries residing in a Nursing Home, a referring NPI is mandatory on the claim. The referring NPI can be obtained from the Nursing Home.


 

Hospice

 

The Hospice section is in the process of being updated. Please email ProviderOutreach@michigan.gov if you have suggestions! Thank you for your patience. 


 

Hospital

 

May 09, 2016: Inpatient ICD-10 Surgical Codes with Documentation Requirements

 

May 05, 2016: ICD-10 Surgical Procedure Codes Requiring Prior Authorization
 

May 04, 2016: A8 Outpatient Hospital Claim Denials

 

April 20, 2016: Re-Billing Hospital Claims

 

April 20, 2016: Three Day Window Billing Tip

 

April 20, 2016: Pricing Outpatient Hospital Claims

 

March 30, 2016: PACER Requirements Billing Tip
 

March 23, 2016: IPH Pricing Billing Tip
 

March 22, 2016: Diagnosis Inconsistent with Procedure Billing Tip
 

February 18, 2016: Credit Balance Billing Tip

 

February 18, 2016: Timely Filing Billing Tip
 

June 04, 2015: How to use the CHAMPS Claim Limit List

March 10, 2015: Inpatient Surgical/ ICD 9 Procedure code documentation requirements

April 08, 2013: How to Find Professional REV Codes
 

  

June 20, 2011: Hysterectomy- When billing for a hysterectomy performed during a beneficiary's period of retroactive eligibility, please indicate in the Remarks section: "No consent not eligible on DOS, Retro MA. PT told prior to HYST unable to reproduce." 

  

June 2, 2011: Inpatient Hospital Rehab- Providers should report appropriate taxonomy code 273Y00000X, 283X00000X, or 283XC2000X ( not 282N00000X). 


 

Nursing Facility

  

November 06, 2015: Level of Care Determination (LOCD) Tool within CHAMPS
 

Nursing Facility Historical Provider Tips


 

Pharmacy/DME

 

April 26, 2016: DME Provider Verification Tool

April 20, 2016: Blood Glucose Monitoring Equipment and Supplies


 

Physician

 

March 10, 2015: Immunizations Administration and Preventive Medicine Services. 


 

Professional