Professional

Resources for all Professional Providers

• Billing the Medicaid beneficiary
• CHAMPS claim status instructions
• CHAMPS Prior Authorization Instructions
• Claim Review Appeal Process Tip
• Compound Drug billing
• Consent for Sterilization Tip
• CSHCS-MC Benefit Plan
• Diagnosis Inconsistent with Procedure
• Documental Management Portal (DMP) Messaging Function for Predictive Modeling
  • Document Management Portal (DMP) for Children's Special Health Care Services
• How to verify associated and authorized billing agents within a provider's enrollment information
• How to use the CHAMPS Claim Limit List
• Incarceration Benefit Plan Billing
• Long-Acting Reversible Contraception (LARC) Tip
• List of Medicaid Health Plans Contact and Service Listing
• Medicaid Health Plans (michigan.gov)
• Medicaid Managed Care Provider Enrollment Requirement Memo
• Medicare Buy-in Requests
• Nursing Facility Therapy Guide
• Other Insurance Reporting Requirements
• Other Insurance CARC Codes Resource
• Outpatient Therapy Guide
• Pharmacist Medication Therapy Management (MTM)- PDF, Q&A
• Predictive Modeling Provider Tip
• QMB Benefit Plan Tip
• Suspended Claims
• Timely Filing (CARC 29) Policy effective January 1, 2017
• Telemedicine

Previously Recorded Webinars

Additional provider specialty-specific resources below

Ambulance

• Emergent Transport Tip
• Excluded Services Tip
• Non-Emergency Transport Tip
• Prior Authorization Requirements Tip
• Two Runs Tip

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

• CHW Beginner Guide
• MMP 23-74
• MI Medicaid CHW Registry

• February 14, 2024: CHW: CHAMPS Provider Enrollment Introduction: PDF, Recording
• February 7, 2024: CHW: MI Medicaid Registry Process- PDF, Recording
• January 13, 2023: Community Health Worker-PDF, Recording, CHW Fact Sheet, FAQ

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.

• May 8, 2023: PDF, CHW Policy Initiative: Policy Primer Series Video 4 can be found here https://www.youtube.com/watch?v=NQupNcMSgx8.
• May 1, 2023: PDF, CHW Policy Initiative: Policy Primer Series Video 3 can be found here https://www.youtube.com/watch?v=OeUzJ4giI1g.
• April 24, 2023: PDF, CHW Policy Initiative: Policy Primer Series Video 2 can be found here https://youtu.be/kBlDNoLhZzU
• April 17, 2023: PDF, CHW Policy Initiative: Policy Primer Series Video 1 can be found here https://youtu.be/nxiWLKSle5c

Community Transition Services (CTS)

Doula 

As of January 1, 2023, Michigan Medicaid began reimbursing for doula services provided to individuals covered by or eligible for Medicaid Insurance. Doula providers seeking reimbursement for their professional services to Medicaid beneficiaries are required to be on the MDHHS Doula Registry and enrolled in CHAMPS as a Medicaid provider. Doulas must contact the Medicaid Health Plans before serving Medicaid Health Plan members. View the final policy: MMP 22-47.

• Beginner Guide for Doula Providers
• August 2, 2023: Doula 101- PDF, Recording, FAQ

Enroll as a Provider

• Become a Medicaid-Enrolled Doula
• MDHHS Doula Registry Application
• CHAMPS Provider Enrollment Doula Instructions- PDF
• After enrolling in CHAMPS, doulas wishing to provide services to Medicaid Health Plan members must become credentialed with each Medicaid Health Plan in the doula’s geographic service area. Credentialing with Medicaid Health Plans is an extensive process and varies by plan; please note the process could take several months.

Verify the Beneficiary or Patient Eligibility

• Eligibility and Enrollment (Member Tab) (michigan.gov)
• List of Medicaid Health Plans Contact and Service Listing

Verify Code Coverage and Restrictions

• Doula-Billing-Guidance
• Doula Fee Screen

Submit or Bill the Claim

• Claims and Encounters (michigan.gov)
• CHAMPS claim status instructions
• Doulas must submit claims for services provided to Medicaid Health Plan members to the Medicaid Health Plan. The Medicaid Health Plan reimburses the doula for services provided to MHP members. To identify which Medicaid Health Plan is associated with a specific county, refer to Medicaid Health Plans: List of Medicaid Health Plans Contact and Service Listing.

Durable Medical Equipment (DME)/ Medical Suppliers

• Blood Glucose Monitoring Equipment and Supplies
• DME Provider Verification Tool
• DME Frequently Asked Questions (FAQ)
• Prior Authorization for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

Physician

• Common Denials
• Emergency Room Charges
• Prior Authorization Tip

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