Institutional

This page is intended for Institutional providers and is categorized by provider type. The following providers must use the ASC X12N 837I 5010 institutional format when submitting electronic claims or the Institutional claims option via the CHAMPS Direct Data Entry(DDE) screens.

  • Clinic- Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Tribal Health Centers (THC)
  • Home Health Agencies
  • Hospice
  • Hospital
  • Nursing Facilities
  • Outpatient Therapy Providers*

* Comprehensive Outpatient Rehabilitation Facilities, Outpatient Rehabilitation Agencies, CARF-Accredited Medical Rehabilitation Programs, CAA-Accredited University Graduate Education Programs

  • Private Duty Nursing Agencies

To access a resource click on the preferred file hyperlink.

 
Resources for all Institutional Providers

 

Additional provider specialty-specific resources below

 
Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Tribal Health Centers (THC)

Facility Settlement


Home Health

August 10, 2017: Home Health Aide services are covered only when ordered by the attending physician and performed in conjunction with direct ongoing skilled nursing care and/or PT.
When submitting claims and reporting aide services along with skilled nursing care or physical therapy, it's recommended to report the services in the following sequential order to allow for proper processing. The nursing and/or PT HCPCS code on the first claim line, followed by the Aide HCPCS codes. 

CHAMPS logic looks for a PAID nursing or physical therapy HCPCS service line during the same calendar month. Therefore, when billing both services on the same claim, aide services could be denied if the service line is billed out of order.


 
 Hospital

Inpatient Specific

When billing MI Medicaid for rehabilitation services MDHHS recommends that providers report the appropriate taxonomy code on all claims submitted. Medicaid commonly sees claims billed for rehab services with the billing provider NPI's taxonomy of 282N00000X for General Acute Care Hospital. The Washington Publishing Company is available for providers to review and associate the correct taxonomy code 273Y00000X Rehabilitation Unit.

Outpatient Specific

Hospice

When uploading the Hospice Election Statement form to DMP, follow the guidelines as listed below:

Document Type: Claim

Document Title: Forms

Date of Service From: Enter the hospice election date

Date of Service to TCN: Enter the hospice election date

Message: Hospice Election Statement

After the alternative form is uploaded, providers may verify receipt by searching the beneficiary ID number in DMP. First-time users of Document Management Portal please review the DMP users guide


Skilled Nursing Facility (SNF)

 

 

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