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Monday, July 16th, 2018 4:35 PM
Dear Colleagues:
This topic was brought up at a previous LHD call and we would like to expand on it by offering a written explanation for when to add CMDS clinic and associated physician and pediatrician NPIs.
As a reminder, CMDS clinics are a CSHCS clinic model that provides a highly coordinated, interdisciplinary approach to the management of specified complex medical diagnoses. Multiple providers along with the family/client come together to a single location on the same day for an extended appointment with all or almost all the providers that the client will need to see.
CMDS clinics need to be authorized as providers using the unique CMDS clinic NPI number so they can bill for the clinic fee, no matter what insurance the beneficiary has.
Additionally, we do authorize pediatricians who take part in the CMDS clinic, since they are part of the beneficiary’s specialty care team and we require them to be a part of the CMDS clinic staff composition.
Please see below for when to add CMDS clinic and associated physician and pediatrician NPIs:
|
|
CMDS Clinic NPI |
CMDS Associated Subspecialist NPI |
CMDS Associated Pediatrician NPI |
|
Beneficiary has CSHCS ONLY |
Always |
Always |
Always, only for DoS |
|
Beneficiary has CSHCS and private insurance |
Always |
Always |
Always, only for Dos |
|
Beneficiary has CSHCS and FFS Medicaid |
Always |
Always |
Never, Medicaid will cover Pediatrician |
|
Beneficiary has CSHCS and is enrolled in a MHP |
Always |
Only one subspecialist per diagnosis |
Never, MHP will need to cover Pediatrician |
CMDS clinics often contain multiple subspecialists, but you will notice that only one subspecialist can be approved per diagnosis for beneficiaries that are enrolled in an MHP. In this case please add the primary subspecialist for each diagnosis, which is often the medical director of the clinic. For example, if the MHP beneficiary has a hematology/oncology diagnosis we would likely want to add the hematologist.
Lastly, families/beneficiaries do not need to be involved in the process of adding NPIs. Providers may send NPIs in to the state directly or to the beneficiary’s LHD, but in either case we do not need the family/beneficiary to confirm that the NPIs that were submitted are correct. The family/beneficiary does not need to be a part of this process.
Please contact Bruce Turnbull at TurnbullB@michigan.gov if you have any questions. Thank you for your attention to this matter.
Theresa Christner, M.A.
Manager, Policy/Program Development Section
Children’s Special Health Care Services Division
Michigan Department of Health and Human Services
320 S. Walnut, Lansing, MI 48933