Medicaid Alerts

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 Description: Description: CHAMPS

Description: Description: Policy Bulletins

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Description: Description: Biller B Aware

September 27, 2016: Attention Outpatient Hospital Providers: Effective September 30, 2016 MDHHS will change the error disposition from suspend to DENY for claims that are split billed, duplicates, or are not those approved by Medicare for repetitive billing.  Current Medicaid policy 7.1.E Date of Service requires all services for a single encounter be billed on one claim with the exception of the services outlined in policy. Claims can be identified with CARC 97 - RARC M86.The claim limit list function in CHAMPS can be utilized to identify the previously paid claim.

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

September 26, 2016: Attention Inpatient Hospital Providers: MDHHS is offering an Inpatient Hospital Updates virtual training on October 6, 2016 from 10:00-11:00 AM. This training will present important topics and updates, including:

  • Inpatient Authorization Requirements
  • Prior Authorization/PACER/Transfers/15 day readmits/CSHCS
  • Claim completion/3 Day or 1 Day Window
  • Newborns
  • Time limit Exceptions
  • Audits/Rebilling rules

Please visit our Medicaid Provider Training page to register.

September 26, 2016: System Outage: Due to CHAMPS Release deployment, the CHAMPS system will be down between 7:00 PM Friday, September 30th 2016 and 2:00 AM Saturday, October 1st 2016. This outage will affect the system access for all functionality. We apologize for any inconvenience.

September 21, 2016: Attention Medicaid Fee-For-Service Nursing Facility Providers: This is an update to the messages posted August 23, 2016 and September 12, 2016 specific to the importance of the Provider Identification (ID) number with the LOC 02 segment in the member’s eligibility file and the facility who conducted the Level of Care Determination (LOCD). 

Effective October 4, 2016 claims will deny for Claim Adjustment Reason Code (CARC) B7 if the LOC 02 segment in the member’s eligibility file does not match the nursing facility’s National Provider Identification Number (NPI)/Provider ID on the LOCD. 

Please refer to letters L 16-13 and L 16-16 for further information. MDHHS has also posted L 16-53 dated September 2016 to provide additional information.

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

September 20, 2016: Attention Nursing Facility Medicaid Fee for Service Providers: Medicaid letter L 16-16 issued on April 28, 2016, informed nursing facilities that the Medicaid Enrollment Checklist was revised. The revision included a new MDHHS local office reminder regarding the submission of a revised MSA-2565-C by the facility if the facility’s NPI/Medicaid Provider ID number changed. This checklist has been revised again to include a reminder that a revised MSA-2565-C must be sent to the local office for all current Medicaid residents and newly admitted Medicaid beneficiaries in the event of a change in a facility’s NPI/Medicaid Provider ID number.

The revised Medicaid Enrollment Checklist is posted online.

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

September 15, 2016: Attention Providers: MDHHS Provider Relations has begun adding recordings of recently conducted virtual trainings on our Medicaid Training site. Recordings will continue to be added and providers are encouraged to check this site regularly to listen to past presentations or to register for upcoming scheduled virtual trainings. 

September 12, 2016:  Attention Medicaid Fee-For-Service Nursing Facility Providers:  This is an update to the message posted August 23, 2016 specific to the importance of the Provider Identification (ID) number with the LOC 02 segment in the member’s eligibility file and the facility who conducted the Level of Care Determination (LOCD). 

Effective October 4, 2016 claims will deny for Claim Adjustment Reason Code (CARC) B7 if the LOC 02 segment in the member’s eligibility file does not match the nursing facility’s National Provider Identification Number (NPI)/Provider ID on the LOCD. 

Please refer to letters L 16-13 and L 16-16 for further information.

A MDHHS Medicaid virtual training entitled “Institutional Level of Care and Patient Pay” is scheduled for September 13, 2016, that will include information about this update.  Please visit the MDHHS Medicaid Training site to register for this training.

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

September 9, 2016:  Attention Nursing Facility Medicaid Fee for Service Providers: Instructions for the Facility Admission Notice (MSA-2565-C) have been revised to indicate:

If there is a change in the nursing facility’s NPI/Medicaid Provider ID number the local MDHHS office must be notified via a revised MSA-2565-C.  A revised MSA-2565-C must be completed for all current and newly admitted Medicaid beneficiaries.  The NPI field must contain the effective date of the NPI.  An MSA-2565-C is not submitted for beneficiaries receiving hospice services in a nursing facility.

The revised MSA-2565-C is posted.   

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

September 9, 2016: Attention Skilled Nursing Facility Providers: MDHHS is offering a Skilled Nursing Facility Document Management Portal (DMP) virtual training on September 14, 2016 from 10:00-11:00 AM. This tool enables Providers to electronically submit supporting documentation related to the Level of Care Determination (LOCD) process. This training will present important topics and updates, including:

• What is DMP?

• Accessing DMP

• Searching for Documents in DMP

• Uploading Documents

• Faxing Documents

• Messaging

• Provider Resources

Please visit our Medicaid Provider Training page to register.

September 2, 2016: System Outage: Due to system maintenance, the CHAMPS system will be down between 6:00 PM Saturday, September 10th through 9:00 AM Sunday, September 11th, 2016. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

September 1, 2016: Attention Outpatient Hospital Providers: MDHHS has identified a system issue causing secondary and tertiary claims to Medicaid to inadvertently pay $0.00. This is primarily happening when the other insurance has no payment amount at the header or the line level but there is beneficiary liability indicated (example: CARC 1, 2, or 3) and MDHHS has liability. This is projected to be fixed in a system release scheduled for December 16, 2016. At that time, MDHHS will identify affected claims and adjust them for correct processing. We apologize for any inconvenience.

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

 

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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

August 01, 2016:  Document Management Portal (DMP) for Children’s Special Health Care Services

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

 

September 27, 2016: PACER Requirements Billing Tip

 

August 11, 2016: Hospital Claim Newborn Coverage Tips

 

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 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

  

August 11, 2016: Denials for LOCD Not Complete

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

 

 
August 16, 2016: Professional Updates