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

 

 

 

 

 

 

 

 

 

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.

May 06, 2016: Attention ALL Providers: The Michigan Departments of Health and Human Services (MDHHS) will initiate claim adjustments on pay cycle 5/12/2016 for HCPCS and CPT codes that have a lifetime limit. Beginning with dates of service from 2011 and continuing adjustments until completed. Previously, lifetime limits were not storing correctly within CHAMPS and claims may have processed incorrectly. The adjustment claims can be identified by the claim note “Lifetime Limit Adjustments to set flag”. The Medicaid Code and Rate Reference Tool can be used to verify which HCPCS and CPT codes have a lifetime limit.

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.

May 04, 2016: Attention Outpatient Hospital Providers: This is an update to the message posted April 7th, 2016 related to APC/OPPS quarterly software updates. Analysis of claims processed on or after March 25th, 2016 show certain service lines are setting incorrect status indicators. Providers may notice an increase in the amount of claims that are suspending for dates of service on or after January 1st, 2016. The correction to this issue is scheduled to be installed May 14th, 2016.  MDHHS will release any suspending claims affected by this issue. MDHHS asks that providers not send in duplicate claims but wait for their suspending claim to be 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.

May 03, 2016: System Outage: Due to CHAMPS Emergency Release deployment, the CHAMPS system will be down between 7:00 PM Saturday, May 7th 2016 and 2:00 AM Sunday, May 8th 2016. This outage will affect the system access for all functionality. We apologize for any inconvenience this may cause.

April 21, 2016: Attention ALL Providers: This is an update to the messages posted October 30th, 2015 and November 10th, 2015 related to Predictive Modeling (PM). The Michigan Department of Health and Human Services (MDHHS) will be requesting medical records for any claim that is flagged for PM. Providers may notice an increase in the volume of affected accounts. MDHHS wants to remind providers that they must attach their medical records to the suspending TCN within 45 days from the date of the medical records request letter. Please do not upload documentation until the letter is sent. Please do not submit duplicate claims until the suspending claim is resolved. Providers can expect their claim to be resolved within 60 days from the date medical records are uploaded through the Document Management Portal (DMP).  Please refer to our PM Frequently Asked Questions for more details.

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

April 12, 2016:  Attention ALL Providers:   This is an update to the message posted on April 11, 2016 related to timeout issues with Core 270/271 Real-time Eligibility transactions.  These issues have now been resolved. MDHHS are still working to analyze this issue and we will continue to monitor the system.  We apologize for any inconvenience.

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

April 12, 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 (RA) 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 12, 2016:  Attention Hospice Providers: The Centers for Medicare & Medicaid Services (CMS) has clarified that the hospice day-count begins when a beneficiary becomes Medicaid eligible and not before.  Therefore, the Michigan Department of Health and Human Services (MDHHS) cannot count days in hospice when the member was self-pay or under another insurance payer. Once the beneficiary becomes Medicaid eligible, Occurrence Code (OC) 27 will need to contain the hospice start date of when the individual became Medicaid eligible and then higher tiered hospice rate for days 1-60 will be paid to the provider.    

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

April 11, 2016: Attention ALL Providers: Core 270/271 Real-time Eligibility transactions are currently experiencing session time-outs. MDHHS is currently monitoring the system to identify the problem. We apologize for any inconvenience and will provide an update once the issue is resolved.

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

April 11, 2016:  Attention PDN Providers: MDHHS has identified a database issue. Claims that were submitted with date of service falling on Easter were paid at the regular rate instead of the holiday rate. MDHHS is working on creating a resolution for this issue and once the issue is resolved, MDHHS will adjust the claims to pay at the correct rate.

April 7, 2016: Attention Outpatient Hospital Providers: Due to delays in coding updates, claims with dates of service on and after January 1, 2016 billed with codes G0477-G0483 will deny with reason code A8. Once the April 2016 APC/OPPS quarterly software updates are completed on June 26, 2016, MDHHS will identify affected claims and resurrect them.

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

April 5, 2016: System Outage: Due to system maintenance, the CHAMPS system will be down Saturday, April 9, 2016 6:00 PM EST through Sunday April 10, 2016 9:00 AM EST. This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

March 25, 2016:  Attention All Providers:  This is an update to the message posted on March 21, 2016 related to technical difficulties with the File Transfer Service (formally known as the Data Exchange Gateway-DEG) .  The issues have now been resolved.  Please contact  AutomatedBilling@michigan.gov with questions.  Thank you.

March 22, 2016: System Outage: Due to system maintenance, the CHAMPS system will be down Friday, March 25, 2016 7:00 PM EST through Saturday March 26, 2016 2:00 AM EST. This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

March 21, 2016:  Attention All Providers:  MDHHS is experiencing technical difficulties with the File Transfer Service (formerly known as the Data Exchange Gateway-DEG).  Additional information will be sent as we receive it.   We apologize for this inconvenience.  Please contact  AutomatedBilling@michigan.gov with questions.  Thank you.

March 18, 2016: Attention ALL Providers: On Sunday, March 20th, 2016, the File Transfer Service (FTS) will undergo screen revisions. All functions will remain the same but screens will look different only when accessing the web interface using the HTTPS Connection. 

**Please DO NOT SEND files through the HTTPS web Internet connection Sunday, March 20th, between 8:00 A.M. and 6:00 P.M. EST

Please review the important information below. You must refer to the Electronic Submission Manual, Section 4, for new information on the FTS.

  • Destination Mailbox is now called “Recipient” (ex. DCHEDI or DCHBULL– must all be in CAPS).

  • Effective March 20, 2016 at 6:00 P.M., the Transfer Mode defaults to binary – previously, the transfer mode defaulted to text.

  • You must refer to the new Electronic Submissions Manual for changes related to the new download file extension .msg, transfer mode.

  • No changes are planned for your current password: refer to Section 7 of the Electronic Submissions Manual for password change information.

Please contact AutomatedBilling@michigan.gov with questions.

March 18, 2016: Attention Nursing Facilities: TPL (Third Party Liability) will be initiating gross adjustments on Medicaid paid claims where there was retroactive Medicare and Medicaid paid primary. These claims are no longer available in CHAMPS. Based on the Medicare claims processing manual Section 70.7.3, the provider is able to bill Medicare if Medicaid recovers for retroactive enrollment up to 6 months from the void/gross adjustment date done by MDHHS.

After submitting claims to Medicare and if there is a balance that has to be submitted to Medicaid, please rebill and report the following in the remarks section: “Bypass timely filing, MCR retroactive enrollment GA takeback balanced owed.”

Providers with further questions can contact provider support by phone1-800-292-2550 or by email ProviderSupport@michigan.gov.

March 3, 2016: System Outage: Due to system maintenance, the CHAMPS system will be down Saturday, March 12, 2016 12:00 PM EST through Sunday March 13, 2016 6:00 AM EST. This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

March 2, 2016: Attention Nursing Facility Providers: When creating the LOCD tool, please enter the member’s Medicaid ID when available. By entering the member’s Medicaid ID, the system will pre-populate the member’s information. If the Medicaid ID is not available, please verify and enter the correct spelling of the member’s first and last name into the system. If a member’s spelling of their name is not entered correctly, the Medicaid ID cannot be captured to that LOCD even if a member’s Medicaid ID exists.

CHAMPS is in the process of creating a warning message for providers to prompt them to review a member’s first name, last name, DOB, and SSN. It is tentatively scheduled to release after June 3, 2016.

Providers with further questions can contact provider support by phone 1-800-292-250 or by email ProviderSupport@michigan.gov.

February 26, 2016: System Outage: Due to system maintenance, the CHAMPS system will be down Saturday, February 27, 2016 6:00 PM EST through 9:00 PM EST. This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

February 23, 2016: Attention ALL Providers: On an ongoing basis, MDHHS will be clearing duplicate ‘Suspending’ claims off of CHAMPS claim inquire and keeping only the most recently submitted claim that has a ‘Suspending’ status. These claims will be denied with Claim Adjustment Reason Code (CARC) 96 and Remittance Advice Remark Code (RARC) N35. Providers who receive this claim denial are encouraged to perform a search within the CHAMPS claim inquire function to identify the other TCN that is ‘Suspending’.

If your claim status shows ‘In Process’ or ‘Suspending’ within the CHAMPS claim inquiry, DO NOT resubmit another claim.

Providers with further questions can contact provider support by phone1-800-292-2550 or by email ProviderSupport@michigan.gov.

February 17, 2016: Attention Nursing Facility Providers: When completing the MSA-2565-C, the facility’s seven digit Medicaid Provider ID number is required in box (12. b.) of the form. The Medicaid Provider ID number associated to the LOC 02 segment in the member’s eligibility file must be that of the Medicaid Provider who conducted the LOCD. If these two do not match, the LOCD tool remains incomplete. Claims may deny with the following CARC/RARC codes: CARC B7, CARC 96 with RARC N216. These codes indicate that the submitting billing NPI does not match to Member LOC 02 authorization in CHAMPS or the LOCD record is not active/not complete/not met. You may contact Provider Support by phone at 1-800-292-2550 or email ProviderSupport@michigan.gov to obtain the seven digit Medicaid Provider ID.

February 08, 2016: System Outage: Due to system maintenance, the CHAMPS system will be down Saturday, February 13, 2016 12:00PM EST through Sunday February 14, 2016 11:59AM EST. This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

February 05, 2016: Attention ALL Providers: The Data Exchange Gateway will be unavailable from 9:00 A.M. EST – 12:00 P.M. EST on Sunday, February 7, 2016. Please do not submit files during this outage. We apologize for this inconvenience.

Please contact AutomatedBilling@michigan.gov with questions.

February 02, 2016: Attention Dental Providers: MDHHS has identified a CHAMPS defect with dental claims. Instead of the system deducting a $3.00 copay for prior authorized services, the system is paying a $3.00 copay. This defect is projected to be corrected in the CHAMPS June 2016 update, after which time MDHHS will adjust identified claims.

Providers with further questions can contact provider support by phone1-800-292-2550 or by email ProviderSupport@michigan.gov.

January 29, 2016: Attention Trading Partners: Web Interface Connection HTTPS for the File Transfer Service (FTS) will be unavailable on Sunday, January 31, 2016 between 9:00 AM through 2:00 PM EST. Please do not submit any files through the HTTPS connection during this time. All other access connections (SFTP, FTP/SSL), will remain available for submission of files.

We apologize for any inconvenience.

January 29, 2016: Attention Trading Partners: This is an update to the message posted on January 19, 2016 related to the File Transfer Service (FTS), previously referred to as the Data Exchange Gateway (DEG). Beginning February 1, 2016, user screens will look different but all functions will remain the same when accessing the Web Interface utilizing an HTTPS Connection. Please review the below information.   

  • Destination Mailbox is now called “Recipient” (ex. DCHEDI or DCHBULL – must all be in CAPS);
  • Transfer Mode defaults to Binary – in the past, the transfer mode defaulted to Text;
  • Refer to the Electronic Submissions Manual (ESM) for changes related to the new download file extension .msg, transfer mode; and
  • There are NO changes to the current password.  Please refer to the ESM, Section 7 for password information.

Please refer to the ESM, Section 4 for updated FTS information. Additional FTS Web Client information, including how to connect and log-in, can be accessed here. 

Please contact AutomatedBilling@michigan.gov with questions.

January 25, 2016: Attention Hospice Providers: This is a reminder to the message posted on October 19, 2015. Effective January 1, 2016, the following billing requirements are being required for all Hospice providers: Routine Home Care Hospice for Hospice claims submitted on/after November 1, 2015, Hospice Certification Date (Occurrence Code 27 & Date) must be reported on every Hospice claim. Hospice claims submitted to MDHHS must be in date sequence order. Please ensure payment is received for the initial Hospice month prior to submitting claims for subsequent months. When applicable, the date of death must be reported using Occurrence Code 55 and Date.

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

January 22, 2016: EDI Virtual Training Series: Three trainings focusing on the life cycle of becoming an authorized billing agent and submitting electronic files to Michigan Medicaid Fee-for-Service.

  1. New Billing Agent Enrollment Application: February 04, 2016: 10 A.M. - 11 A.M. EST
    Intended for businesses seeking to submit Fee-for-Service electronic files directly to Michigan Medicaid without the use of a clearinghouse.
  2. Ramp Manager/Connection Options: February 18, 2016; 10 A.M. – 11 A.M. EST
    Intended for approved billing agents that are in the process of completing file testing.
  3. Production: March 3, 2016; 10 A.M. – 11 A.M. EST
    Intended for approved billing agents that have successfully completed file testing and have been approved by Michigan Medicaid to submit production files.

To register for these trainings, please select the Virtual Training Registration link.
*You must register individually for each of the three offered trainings*
*If you have not been issued a submitter ID number, please enter your contact phone number (omit dashes) in the NPI or Submitter ID field of the registration form*


Please contact AutomatedBilling@michigan.gov for further assistance.

January 21, 2016: Attention Hospice Providers: This is a reminder to the message posted on October 19, 2015.  Effective January 1, 2016, the following billing requirements are being required for all Hospice providers: Routine Home Care Hospice for Hospice claims submitted on/after November 1, 2015, Hospice Certification Date (Occurrence Code 27 & Date) must be reported on every Hospice claim.  Hospice claims submitted to MDHHS must be in date sequence order.  Please ensure payment is received for the initial Hospice month prior to submitting claims for subsequent months. When applicable, the date of death must be reported using Occurrence Code 55 and Date.

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

January 21, 2016: Attention ALL Providers: CHAMPS Document Management Portal (DMP) and CHAMPS Archived Documents function will be unavailable from Friday January 22, 2016 at 6:00 PM until Monday January 25, 2016 at 12:00 AM to allow for maintenance and upgrades for document archiving and retrieval. We apologize for any inconvenience.

January 20, 2016: Attention ALL Providers: The Plan First! Program is coming to an end. In the next couple of weeks, MDHHS will be reviewing Plan First! recipients eligibility for other Medicaid programs. MDHHS would like to remind Plan First! recipients to update their mailing address and phone number. MDHHS is requesting this poster be printed on 8.5 by 14 inch paper and prominently displayed in your waiting or reception area(s). An all provider bulletin regarding the termination of the Plan First! Program will be issued shortly.

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

January 19, 2016: Attention Trading Partners: Beginning February 1, 2016, the Data Exchange Gateway (DEG) will be renamed as File Transfer Service (FTS).  Please review the information below.

  • There is now a Java Mode option and Non-Java Mode option  - please use the Java Mode option for full functionality;
  • Destination Mailbox is now called “Recipient” (ex. DCHEDI or DCHBULL– must all be in CAPS); and
  • Transfer Mode defaults to Binary - prior to February 1, 2016, the transfer mode defaulted to Text.  The text transfer mode must be manually selected.

Please contact AutomatedBilling@michigan.gov with questions.

January 19, 2016: Attention Inpatient Hospital Providers: MDHHS has identified a CHAMPS defect with Inpatient Hospital claims span billing the ICD-10 implementation date that are not triggering the alternate NICU DRG rate. These inpatient claims billed with the revenue code 0174 are paying at the normal DRG rate. This defect is projected to be corrected in the March 25, 2016 CHAMPS update, after which time MDHHS will adjust identified claims to ensure they assign the alternate NICU DRG rate.

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

January 19, 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 phone1-800-292-2550 or by email ProviderSupport@michigan.gov

January 12, 2016: Attention ALL Providers: This is an update to the message posted on January 11, 2016, related to technical issues with outbound files. The electronic file technical difficulties are now resolved. Please check frequently for files that you normally receive from MDHHS Michigan Medicaid. Please do NOT resubmit a file to MDHHS Michigan Medicaid unless you have received an acknowledgement file indicating that your file was rejected. Please contact AutomatedBilling@michigan.gov for further assistance.

We apologize for any inconvenience and will continue to monitor file traffic and provide any updates as necessary.

January 11, 2016: Attention ALL Providers: MDHHS Medicaid EDI is experiencing a technical difficulty with the SFTP for inbound and outbound files. Please expect delays with the receipt of 999 acknowledgement files. This affects all Data Exchange Gateway (DEG) submissions including HTTPS and SFTP connections.

We apologize for the inconvenience and will post an update when the issue is resolved.

Please contact AutomatedBilling@michigan.gov with questions.

 

 

 

 

 

 

 

 2015

 2014

 2013

 

 

 

2012

Description: Description: 2011

Description: Description: 2010

 

 


 

 

 

 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

 

 

 

 Description: Description: Private Duty Nursing

Professional

 

 

 

 


 

 

 

All Providers

 

 

 

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


October 01, 2013: MDCH-ICD10 Virtual Training

 

March 07, 2013ICD-10 Virtual Training 

 

December 11, 2012: ICD-10 Presentation 

 

December 3, 2012: Medicare Part D Coverage of Benzodiazepines and Barbiturates 1/1/2013.

As of January 1, 2013, Medicare Part D plans will begin covering benzodiazepines and barbiturates (i.e. barbiturates used in the treatment of epilepsy, cancer, or a chronic mental health disorder). For additional information on the Part D coverage changes, please visit the Michigan Medicaid website https://michigan.fhsc.com 


October 26, 2011:  5010 Professional DDE

October 26, 2011:  5010 Institutional DDE

October 3, 2011:  Local CSHCS Office Contact Info

January 15, 2010:  PERM Audit Information

August 27, 2008:  CMS 1500 Claim Completion Instructions 

June 14, 2005:  Listserv Instructions- Updated 09.22.2009 

 

 

 


 

 

 

 

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. 

 

 

 


 

 

 

 

Private Duty Nursing

 

 

 

 

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

 

 

 


     

 

Professional