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Beneficiary Eligibility Verification

Beneficiary Eligibility Verification

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Eligibility Verification Options: card

BENEFIT PLANS: 

  • Providers will now need to utilize the Benefit Plan ID(s) indicated in the eligibility response to determine a beneficiary's program coverage and related covered services for a specific date of service. 
  • Benefit Plan data is assigned by the CHAMPS Eligibility and Enrollment (EE) Subsystem based on the source of the data (e.g., Medicaid, CSHCS, etc.) and program assignment factors (e.g., scope/coverage codes, level of  care codes, etc.). 
  • Benefit Plan ID table

The following options are available for enrolled MI Medicaid Providers to verify eligibility for the Medicaid, Healthy Michigan Plan, CSHCS, MOMS, and MIChild programs:
 

 CHAMPS - Eligibility Inquiry: 

  • Online Eligibility Inquiry is now available for Providers.  
  • To access the CHAMPS system you must log onto https://milogintp.michigan.gov
  • Instructions on how to obtain a user ID/password and to subscribe to CHAMPS: MILogin Instructions  
  • Go to the 'Provider Portal', then 'Member' section, then click on the 'Eligibility Inquiry' hyperlink. 
  • See Policy Bulletin  MSA 09-30  and MSA 09-46  for more information. 

 

Michigan Public Health Institute is now able to accept Real-Time/Batch HIPAA 270/271 transactions from all Providers, Billing Agents, and Clearinghouses registered with CHAMPS. These services are provided on behalf of MDHHS and are available free of charge.

MI Healthplan Benefits Website: This website allows users to submit individual or multiple eligibility inquiries (up to 15 at a time) using a single date of service (DOS) or DOS span. The website contains an online enrollment form.

  • X12 270/271 (Real time) HIPAA Transaction: This transaction allows users to submit individual eligibility requests at any time using a single DOS or DOS span. This option provides an immediate real time response to each eligibility request. 
  • X12 270/271 (Batch) HIPAA Transaction: This transaction allows users to submit a batch file at any time and receive a response file within 24 hours. 

    Out-of-state providers: 

  • Contact Provider Inquiry at 1-800-292-2550 to verify eligibility. 

card 

Verifying Eligibility with the mihealth card: 

  • The mihealth card does not contain eligibility information and does not guarantee eligibility. 
  • Providers must verify eligibility using one of the options indicated on this page prior to rendering services. 
  • Use the beneficiary ID number search option and enter the ID located on the front of the mihealth  card. 
  • Additional search options are available if a beneficiary does not have the mihealth card.  

Eligibility Inquiry - Beneficiary Search Options: 

The following search options are available using the CHAMPS Eligibility Inquiry and/or 270/271 transaction:  

1. Beneficiary ID number or Client Identification Number (CIN) (MIChild Inquiries only) 

Or 

2. Beneficiary social security number and date of birth 

Or 

3. Beneficiary name and social security number (or date of birth). 

 Eligibility Response Information: Beneficiary information is confidential under federal guidelines and must be used only for verifying beneficiary eligibility. If the beneficiary is eligible, the following information is available from the eligibility response: 

  • Benefit Plan data for the date of service, which is assigned by the Eligibility Subsystem based on the source of the data (e.g., Medicaid, CSHCS, and MOMS) and program assignment factors (e.g., scope/coverage codes, Level of Care [LOC] codes, etc.). Providers will need to utilize the Benefit Plan ID(s) indicated in the response to determine a beneficiary's program coverage and related covered services for a specific date of service. 
  • LOC information (including the LOC code), Source Provider ID (supplied through local MDHHS offices), National Provider Identifier (NPI), provider name, telephone number, address, and patient pay amount, if applicable.  
  • Medicaid Health Plan (MHP) Primary Care Physician (PCP), including the PCP name, telephone number, and NPI. (Note: Data provided only if the date of service is the current date.) 
  • Third-Party Liability (TPL), including the payer name, payer ID, coverage type code, group number, policy number, and policy holder ID.  Note: If the TPL listed is no longer active or if is not being reported in the response, please contact Provider Inquiry at 1-800-292-2550 or complete an Online Request at www.michigan.gov/reportTPL 
  • CSHCS restriction data, including qualifying diagnosis code(s) and authorized provider list if the provider submitting the inquiry is authorized for the date of service. 
  • Other information: Transaction date (when the data was applied to the Eligibility Subsystem), current county of residence, MDHHS case number, MDHHS worker load number, and MDHHS local office home number. 
  • Pending Eligibility 

Eligibility Policy:  

  • Provider Manual   
  • Go to the Beneficiary Eligibility Chapter: Section 3 - Verifying Beneficiary Eligibility 

Need more information 

Contact Provider Inquiry: 

MDHHS/Provider Inquiry
P.O. Box 30731
Lansing, MI 48909-8231 
Phone: 1-800-292-2550 
E-mail: ProviderSupport@michigan.gov  

mihealth Card