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

August 22, 2016: System Outage: Due to a CHAMPS Emergency Release, the CHAMPS system will be down between 7:00 PM through 11:00 PM on Friday, August 26th, 2016. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

August 23, 2016: Attention Nursing Facility Medicaid Fee for Service Providers:  MDHHS would like to remind providers of the importance of their Medicaid 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).  Medicaid will continue to remind facilities of this information as claims may deny in the future if the LOC 02 segment in the member's eligibility file is not that of the facility that conducted the LOCD and/or match the claim NPI.

Please refer to L-Letter 16-13 for additional information. 

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

August 18, 2016: Attention Trading Partners and Providers: Due to a system issue, electronic files submitted after 4:55AM on 08/17/2016 through 11:00AM on 08/18/2016 will see duplicate 999’s. This system issue has been resolved and there is no need to resubmit any files. If you do NOT receive a 999, please contact AutomatedBilling@michigan.gov

August 16, 2016: Attention Providers: The File Transfer Service (FTS) portal will be unavailable on Sunday, August 21, 2016 from 10:00AM to 2:00PM. Please refrain from submitting files during this maintenance period. We apologize for any inconvenience this may cause.

Please contact AutomatedBilling@michigan.gov if you require further assistance.

August 11, 2016: Attention Providers: MDHHS is continuing to see a high volume of claim denials where the ordering/referring provider is not enrolled in CHAMPS. Ordering/referring providers are encouraged to share their individual NPIs with rendering providers so they may submit the information required for payment of claims.

A CHAMPS Provider Verification screen is available for providers to verify if an ordering/referring provider is enrolled/registered with Michigan Medicaid.  Select the My Inbox tab within CHAMPS and choose the Provider Verification option in the drop-box menu.  Enter the NPI of the referring/ordering provider and select Verify.

Ordering/referring and attending providers must be enrolled and active in the Michigan Medicaid program on the date of service.

Please refer to MSA 12-55 and MSA 13-17 for additional guidance.

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

August 10, 2016: Attention Providers: MDHHS Provider Relations has created a new Provider Inquiry Email Form for Medicaid Providers. This form includes information that Medicaid Provider Relations needs to answer most inquiries. Once you have downloaded this document, complete and save the form to your computer and attach it to your email to ProviderSupport@Michigan.gov

Providers with further questions can contact Provider Support by email at ProviderSupport@michigan.gov.

August 9, 2016:  Attention Ambulance Providers: MDHHS is seeing an increase of emergency ambulance transport claims denying CARC 50 for a non-supporting emergency ambulance diagnosis code. Providers are not utilizing the highest specificity of the diagnosis code, when possible.  For example, using DX S82899A: Unspecified fracture of unspecified lower leg. The more specific DX code could be S82891A: Other fracture of right lower leg or S82892A: Other fracture of left lower leg. The Medicaid Code and Rate Reference Tool can be used to verify which diagnosis codes support Emergency Transport by having an ambulance indicator.

Also, many providers are not utilizing the emergency in Loop 2400, SV109 segment or the CMS 1500, 24C to indicate emergency services. If left blank, the indicator defaults to N, which indicate no.

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

August 03, 2016: System Outage: Due to CHAMPS system maintenance, the CHAMPS system will be down between 6:00 PM Saturday, August 13th, 2016 through 9:00 AM Sunday, August 14th, 2016. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience. 

August 03, 2016:  Attention ALL Providers: This is an update to the message posted July 25, 2016 regarding Children’s Special Health Care Services (CSHCS) migration from the Covisint Provider Link (EZ Link) to the CHAMPS Document Management Portal (DMP) effective August 1, 2016. 

A user guide for providers is now available to assist in this migration. 

Providers with further questions may contact Kristie Ferris at 517-241-9702 or FerrisK1@michigan.gov for assistance.

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.
 

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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

 

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 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

  

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