Local Health Department
 

 

Determination of Rate - Group Definitions:  (November 2019 and forward)

Group 1 - Total visits are defined as a face-to-face billable service which relates to procedures listed under this group in the LHD database.
Group 2 - Any services administered for vision and/or hearing screens.
Group 3 - Vaccines are counted by the associated administration fees (visit =1).
Group 4 - Total visits are defined as a face-to-face billable service which relates to procedures listed in the LHD database and are billed under the Family Planning Clinic enrolled NPI.
Group 5 - Blood lead services that are billable units for the procedures listed under this group in the LHD database.


For additional pertinent coverage parameters, such as documentation and billing indicators, refer to the Medicaid Code and Rate Reference tool, which is accessible via the External Links menu within CHAMPS.  Medicaid Code and Rate Reference is an online code inquiry system that provides real-time information for the following:

  • Age restrictions,
  • Diagnoses allowable for Ambulance,
  • Documentation requirements,
  • Frequency limitations,
  • Hospital discharge – Bypass PA
  • NDC information,
  • Prior authorizations and medical conditions that may bypass these requirements,
  • Rate information,
  • Required modifiers,
  • Supplies/DME – per diem, and
  • Tooth number and surface requirements.

To request or view upcoming training sessions please refer to Michigan Department of Health and Human Services website at www.michigan.gov/medicaidproviders >> Communications and Training >> Medicaid Provider Training Sessions.

Any questions should be directed to Provider Inquiry, Michigan Department of Health and Human Services, phone toll-free 1-800-292-2550 or email at providersupport@michigan.gov.


      Medicaid Cost Based Reimbursement (MCBR) Budget / Financial Status Report (FSR) Instructions

       Local Health Department Outreach