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Institutional

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

CHAMPS Provider Contact Information

MDHHS utilizes provider email address information entered in the CHAMPS provider enrollment application to communicate with providers. Providers are responsible for maintaining accurate and valid email address information within their CHAMPS provider enrollment information. If email information is out of date or incorrect enrolled providers will want to modify their enrollment information and submit it for approval.

For instructions on how to update or modify email addresses reference the Provider Enrollment webpage step-by-step enrollment guide resources.

To access a resource click on the preferred file hyperlink.

Resources for all Institutional Providers

 

Previously Recorded Webinars

Attending Provider Tips

Additional provider specialty-specific resources below

Community Health Worker (CHW)

A CHW/community health representative (CHR) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between the health/social services and the community to facilitate access to services and improve service delivery's quality and cultural competence. The CHW/CHR is a non-licensed public health provider that facilitates access to needed health and social services for beneficiaries. CHW services focus on preventing disease, disability, and other chronic health conditions or their progression, and promoting physical and mental health. These services are designed to be person-centered and patient-driven, with a focus on beneficiary empowerment, fostering self-advocacy skills to promote personalized and effective diagnosis or treatment.

Resources

Policy Primer Video Series

The Michigan Department of Health and Human Services Behavioral and Physical Health and Aging Services Administration engaged stakeholders with its efforts to ensure a diverse perspective was captured to inform and provide recommendations to MDHHS around defining CHW services, qualifications, supervision, and other required policy elements. The Policy Primer Series consisted of four, short, recorded policy initiative updates which launched weekly beginning on April 17th. This series was created to support the sharing of Medicaid CHW policy initiative progress and to encourage active collaboration from you, the stakeholders. An additional video was released each week until May 8th, 2023. The topics included Managed Care Organization versus Community Provider Distinction, Provider Qualifications, and Covered Services and Reimbursement.

 

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

Facility Settlement

Home Health

Electronic Visit Verification (EVV)

As of April 1, 2024, Home Health Fee for Service providers are required to use Electronic Visit Verification (EVV). MDHHS requires the use of Electronic Visit Verification (EVV) for HHCS for Medicaid Fee-for-Service (FFS) providers serving Medicaid beneficiaries. For dates of service on or after April 1, 2024, certain HHCs require EVV (G0151, G0152, G0153, G0156, G0299, and G0300). Failure to comply will impact payment. 

As outlined in MMP 24-11 for dates of service on and after April 1, 2024, MDHHS will require the submission of EVV data for certain home health care services (HHCS). For Home Health Agency providers who complete the CHAMPS enrollment they should move on to the next step and complete the HHAeXchange provider onboarding form. This will allow HHAeXchange to create the EVV provider portal and work with the Agency to begin the EVV process. The onboarding form must be completed even if the Home Health Agency plans to continue to use their existing EVV vendor. 

To learn more about EVV visit www.Michigan.gov/EVV. For questions or help contact HHAeXchange at 1-855-400-4429 or visit the Michigan Information Center website at www.hhaexchange.com/info-hub/Michigan.    

The MDHHS Home Health Team reviewed EVV usage with providers, addressed provider concerns, and offered updates on policy and procedure. For a list of EVV Frequently Asked Questions (FAQ) visit the EVV Caregivers and Providers - FAQs (michigan.gov).

Reminder, the first home health therapy claim received for a beneficiary will initiate the 60 consecutive-day period. Claims submitted must be in sequential order (e.g., 4/01/2025, 4/08/2025, 4/15/2025) to prevent the incorrect home health therapy start date. Additionally, it is advisable to submit one claim per beneficiary each week to avoid confusion and processing errors. Home Health Agencies who have identified paid claims in CHAMPS submitted in non-sequential order will need to initiate the claim void process within the HHAeXchange system to resubmit claims in sequential order.

**Failure to initiate the claim void process, will result in reimbursement issues and an incorrect start date for the 60 consecutive-day period.**

Hospital

Inpatient Specific

Rehabilitation Services:   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 X12 reference website is available for providers to review and associate the correct taxonomy code;273Y00000X Rehabilitation Unit.

  • Common Claim Denial Reason Code (CARC) 16 Remark Code (RARC) N20 

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 the Document Management Portal review the Document Management Portal Overview. 

Skilled Nursing Facility (SNF)

A Medicaid-certified nursing facility is defined as a nursing home, State Veterans’ Home, county medical care facility, or hospital long-term care unit with Medicaid certification. Also included are swing beds as defined in the Federal State Operations Manual (SOM) and/or State Medicaid Policy.

MDHHS uses a standard assessment and process for all programs and services that require an individual meet the nursing facility level of care. Programs may not use any other assessment in place of the Level of Care Determination (LOCD) tool for this determination. The LOCD assures a consistent and reliable process for determining that individuals meet the functional eligibility requirements. Providers may access the LOCD online in CHAMPS.

 

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