HIPAA - Companion Guides

Michigan Medicaid utilizes the HIPAA compliant ASC X12 Version 5010 format for HIPAA transactions, except those with retail pharmacies. Pharmacy transactions must use the NCPDP standard. This standard applies to claims, payments, and enrollment electronic transactions.

The manuals and guides listed below are designed to assist providers and billing agents in creating and submitting electronic files along with viewing electronic payment and enrollment files. Additional information can be found in the Electronic Submission Manual (ESM).

Health Plans

Questions regarding 834 and 820 files may be sent to: MDHHS-MSA-MCSystemOps@Michigan.gov

Fee-for-Service (FFS)

835/Electronic Remittance Advice (ERA)

To change or update the receiver of the 835 a provider modification needs to be submitted within CHAMPS.
Instructions: How to associate a billing agent and authorize the 835.
Authorize a billing agent to receive the 835/ERA - PDF
End date the 835/ERA authorization - PDF

Questions regarding 835 and 837 files email: AutomatedBilling@Michigan.gov

Medicaid Encounter Technical Guidance

Questions regarding Medicaid Encounter Technical Guidance may be sent to: MDHHSEncounterData@Michigan.gov

Medicaid Encounter Quality

Encounter Timeliness Report Guidelines

Questions regarding Medicaid Encounter Quality may be sent to: MDHHS-ENCOUNTER-QUALITY@Michigan.gov

BHDDA Encounter Guidance

Additional Resources

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HIPAA - Companion Guides

835/Electronic Remittance Advice (ERA)