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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

Attending Provider Tips

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

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)


Modernizing Continuum of Care (MCC)

In January 2018 the Michigan Department of Health and Human Services (MDHHS) implemented the first phase of the Community Health Automated Medicaid Processing System (CHAMPS) Modernizing Continuum of Care (MCC) project.

The key features include:

  • Level of Care (LOC) codes were replaced by Program Enrollment Type (PET) codes. The PET codes more precisely reflect program options and provide additional information on living arrangements and exemption reasons. Information regarding LOC to PET changes, including a list of the new PET codes, is provided in Bulletin MSA 17-40.
  • Specific providers directly enter admission or discharge information in CHAMPS. This can result in real-time changes to the beneficiary’s PET code.
  • Providers can view a roster of all beneficiaries for whom they have submitted admission information in CHAMPS. The roster allows the provider to see an individual’s admission, Medicaid status, and information on discharged beneficiaries.
  • When an SNF enters admission information for an individual who does not have active or pending Medicaid eligibility, a Medicaid Application for Health Care Coverage Patient of Nursing Facility (DHS-4574) will be automatically mailed to the beneficiary.
  • Patient Pay Amounts (PPA) segments are provided separately in a new “Patient Pay” section at the bottom of the eligibility response page. The data is no longer part of the LOC segment, which has been removed from the eligibility response page.

Policy Bulletins  MSA 17-33  MSA 17-40  MSA 17-46

Virtual Trainings

MCC Updates

  • March 28, 2018 – PDFQ&A
  • February 28, 2018 – PDF

Post Implementation

  • January 25, 2018 – PDFQ&A
  • January 11, 2018 – PDF

Overview

  • December 7, 2017 – PDFQ&A
  • November 16, 2017 - PDFQ&A
  • September 18, 2017 – PDFQ&A

 

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