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    Description: Medicaid Alerts

     

     

     

     

     

     

     


     

     

     

    Description: Description: Biller B Aware

    Description: Description: Provider Tips

    Description: Description: Medicaid Providers

     

     

     

    Description: Description: Provider Manual

    Description: Description: Provider Fee Schedule

    Description: Description: Forms

     

     

     

    Description: Description: Documentation E Z Link

    Description: Description: Policy Bulletins

    Description: Description: ICD10

     

     

     

    Description: Description: Email Provider Support

    Description: Description: CHAMPS

    Description: Description: Phone Menu for Provider Support

     

     

     

     

     

     

     

     

     


     

     

     

    Description: Description: Biller B Aware

     

     

     

     

     

     

     

     

     

    April 15, 2014: Attention ALL Providers: MDCH Third Party Liability (TPL claims processing) has identified and will adjust claims which were incorrectly over paid in CHAMPS by not reducing payment correctly when there was more than one service line of other insurance information reported. Current policy outlined in the Medicaid Provider Manual within the Coordination of Benefits chapter, “MDCH payment liability for beneficiaries with other insurance is the lesser of the beneficiary's liability (including coinsurance, copayments, or deductibles), the provider's charge minus contractual adjustments, or the maximum Medicaid fee screen minus the insurance payments.” These claims may be identified by the following note: “adjustments – Lesser of Logic correction.”

    April 15, 2014
    : Attention ALL Providers: MDCH Third Party Liability (TPL claims processing) will be adjusting claims to correct a system defect within CHAMPS which allowed claims and service lines to process for payment in error. The other payers claim adjustment reason codes (CARC) were not appropriate for Medicaid to make reimbursement based upon current policy outlined in the Medicaid Provider Manual within the Coordination of Benefits chapter “MDCH does not pay for services denied by Medicare or other insurance plans due to noncompliance with Medicare or other insurance plan requirements.” These claims may be identified by the following note: “CARC reported does not allow payment.”

    April 15, 2014
    : Attention ALL Providers and Trading Partners: Due to the Heartbleed virus, all accounts interfacing with the State of Michigan’s Data Exchange Gateway (DEG) system are required to change their passwords by 5:00 p.m. on Friday April 18, 2014. This includes all passwords associated with individual users as well as automated systems. If you do not change your password by this date and time, your password will be disabled and you will be unable to submit any files.  If you have any questions, please contact AutomatedBilling@michigan.gov

    April 15, 2014
    : UPDATE: In regards to the message posted on April 7, 2014 for Institutional providers; providers should no longer be experiencing the DDE screen error message when entering a secondary or tertiary claim when the other payer’s information does balance on the claim.

    April 10, 2014
    : Attention Outpatient Hospital Providers: Due to APC software updates, MDCH has resurrected claims for dates of service on or after January 1, 2014, that previously denied for procedure code G0463. Providers can identify the affected claims by reviewing the claim note which will read “G0463 resurrects.”

    April 07, 2014
    : Attention Institutional Providers: Providers submitting secondary/tertiary claims through the CHAMPS portal using Direct Data Entry (DDE) with a claim adjustment reason code (CARC) reported at the header with a value ending in .00 are receiving the following message in error: “Total submitted charges is not equal to the sum of Payments and CARC amounts for payer” when the charges and other payers information does balance. Providers are encouraged to submit these claims through their electronic vendor until this defect has been resolved, a subsequent message will be posted once resolved.

    April 07, 2014: System Outage: Due to system maintenance, CHAMPS will be down between 6:00 PM Saturday, April 12, 2014 thru 6:00 AM Sunday, April 13, 2014. This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

    April 02, 2014
    :
    Attention ALL Providers: This is an update to the Biller B Aware posted on February 25, 2014, in reference to Section 1104 of the Affordable Care Act (ACA). As of March 28, 2014, MDCH will set informational edits which will be used to alert providers when their billing agent is not properly associated to their NPI within CHAMPS. The codes used to communicate this issue will be claim adjustment reason code (CARC) 96 -Non-covered charges and remittance advice remark code (RARC) N55 -Procedures for billing with group/referring/performing providers were not followed.

    Providers are encouraged to resolve this as soon as possible, by updating their Provider enrollment application within CHAMPS and associate the appropriate billing agent. Another Biller B Aware will be posted in the near future to inform providers of the date these edits will be changed to a deny level edit.   


    April 02, 2014
    : Attention Outpatient Hospital Providers: All paid claims with dates of service on or after 1/01/2014 will be adjusted with the newly loaded January APC software updates and will begin to appear on pay cycle 14 (4/03/14).  Adjusted claims can be identified by the claim note “APC Jan 2014 quarterly updates”. Please review the following for information on how to verify the Adjustment Source of your claim http://www.michigan.gov/documents/mdch/How_to_verify_Adjustment_source_july_2013_426808_7.pdf

    April 02, 2014
    : Attention ALL Providers: Beneficiaries may have Medicare Advantage Plans with an additional Traditional or PPO BCBSM policy that includes medical and hospital coverage. “Federal regulations require that all identifiable financial resources be utilized prior to expenditure of Medicaid funds for most health care services provided to Medicaid beneficiaries.”  In most cases, the beneficiary has coverage with a Medicare Advantage plan and a BCBSM Traditional or PPO plan that covers medical and hospital services. Providers must bill all resources prior to billing Medicaid. Any questions on how to report other insurance information on your claims, please contact the Provider Hotline at 1-800-292-2550.

    March 20, 2014:
     System Outage: Due to system maintenance, CHAMPS will be down Friday March 28, 2014, between 7:00 PM through 11:00 PM. This outage will affect CHAMPS system access for all functionality, we apologize for any inconvenience.

    March 20, 2014
    Attention Dental Providers: Since the initial release of CHAMPS in 2009, procedure code D9240 has paid in error when billed for places of service that are not appropriate based on the CDT description. The system has been corrected and MDCH will be performing adjustments to recover the incorrect payments as of 04/15/2014. To avoid financial hardship, providers are encouraged to adjust their claims prior to this date and include the following note “rebilling for change in place of service.”

    March 05, 2014
    : Attention ALL Providers: Due to system maintenance, CHAMPS will be down between 6:00 PM Saturday, March 8 thru 6:00 AM Sunday, March 9, 2014. This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

    March 03, 2014:
    Attention Nursing Facility Providers: Medicare Coinsurance rates for 2014 will not be loaded in CHAMPS until March 28, 2014. This is resulting in Coinsurance day claims, reporting value code 82, to be reimbursed at zero dollars in error. Once the 2014 Coinsurance rates have been loaded into CHAMPS MDCH will adjust any incorrectly paid claims. 

    March 03, 2014:
    Attention ALL Providers: Michigan Department of Community Health (MDCH) will be converting to the ADA 2012 and the CMS 1500 (Version 02/12) paper claim formats. Effective March 22, 2014, MDCH will be implementing a hard cut-over to the new formats for claim adjudication. Claims received using the previous formats on or after this date will be returned to the provider for resubmission utilizing the new claim forms. Providers are encouraged to review MSA 14-07  for further information and guidelines.

    February 25, 2014
    : Attention ALL Providers: Due to a problem with the eligibility system, eligibility for some beneficiaries was incorrectly showing SPENDOWN and Medicare primary indicating that the beneficiary was enrolled within the Special Low Income Medicare Beneficiary (SLMB) benefit plan. If a claim denial with claim adjustment reason code (CARC) 31 was received, providers should re-verify eligibility for that date of service and re-bill any claim(s) if necessary.

    February 25, 2014
    Attention ALL Providers: Per Section 1104 of the Affordable Care Act (ACA), MDCH will begin enforcing providers who submit Fee for Service (FFS) electronic claims to verify eligibility or claim status. Within CHAMPS Provider Enrollment, providers will need to verify that all appropriate Billing Agents who submit any electronic transactions on their behalf are listed. Billing Agents have received a letter regarding this association requirement which included their CHAMPS Billing Agent/Provider ID, as well as how they can review which providers currently are associated to them within CHAMPS. However, this association can only be made by the provider.

    Providers must go into their CHAMPS Provider Enrollment information and verify that they have ‘Billing Agent’ under the “Mode of Claim Submission “step. The correct CHAMPS Provider ID associated to the billing agent needs to be listed in the “Associate Billing Agent” step. If the correct billing agent is not listed within the Provider Enrollment information, it will need to be added and updated and the “Submit Modification Request for Review” step must be completed.

    Failure to comply could result in claim denials and lack of payment in the future.

    February 25, 2014:
     Attention Nursing Facilities and Hospice Providers:


    REPORTING OCCURRENCE SPAN CODE 80 WHEN BILLING FOR ADMISSIONS NOT COVERED BY CMS DENIAL OF PAYMENTS FOR NEW MEDICAID ADMISSIONS


    Effective April 1, 2014, when a nursing facility that is under a payment ban needs to submit a claim for a Medicaid beneficiary readmission that is not subject to the payment ban, the nursing facility must report Occurrence Span Code 80 and the from/through dates the beneficiary resided in the same nursing facility prior to the payment ban.


    Medicaid policy and guidelines for the definition of a new admission are published in the Medicaid Manual, Nursing Facility Chapter, Certification, Survey, and Enforcement Appendix, Section 5.7 Denial of Payment for New Admissions (DPNA).


    Hospices must also report in the above manner when billing for “room and board” when a nursing facility that is under a payment ban needs to submit a claim for a Medicaid beneficiary readmission that is not subject to the payment ban. Hospices can obtain Information regarding a CMS denial of payments for new Medicaid admissions from the nursing facility.


    February 10, 2014
    :Attention ALL Providers: Per the Affordable Care Act the 271 eligibility transaction no longer reports the Special Low Income Medicare Beneficiary,SLMB, Benefit Plan. On the 271, it will return within the EB04 segment the SPENDOWN Benefit Plan, and within another EB04 segment it will return Medicare. This will indicate to providers that the beneficiary is enrolled within the SLMB Benefit Plan. In order to remain compliant CHAMPS eligibility also no longer shows the SLMB Benefit Plan. The SPENDOWN benefit plan will be displayed with the other insurance hyperlink active showing the Medicare policy information; this will indicate to providers that the beneficiary is enrolled within the SLMB Benefit Plan. 
    Policy guidelines can be found within the Provider Manual, COB chapter section 2.6.E. MEDICARE BUY-IN/MEDICARE SAVINGS PROGRAM.

    February 4, 2014
    : Attention Hospice Providers: Effective March 29, 2014 The Michigan Department of Community Health in compliance with NUBC (National Uniform Billing Committee) will require all Hospice claims to report the  ADMISSION/START OF CARE DATE on their claim. Failure to report date of admission will result in the claim rejecting with reason/remark code 16/N46.

    February 3, 2014
    : Attention ALL Providers:  Effective January 26, 2014.  MDCH released a new feature in CHAMPS.  This implementation introduced Phase I of the Document Management Portal (DMP) now accessible for all CHAMPS users.
    Information and tutorials on the Documentation Management Portal are available on the MDCH website at www.michigan.gov/medicaidproviders >> Document Management Portal

    January 28, 2014
    : Attention ALL Providers: System maintenance window for the DEG (Data Exchange Gateway) is scheduled for Saturday, February 1, 2014. The scheduled down time will be from 10:00 a.m. to 12:00 p.m. During this downtime please do not submit any files for the above time period.


    January 28, 2014
    : Attention ALL Providers:
    Michigan Department of Community Health (MDCH) is in the process of remapping many of the following code sets: Claim Adjustment Reason Codes (CARC) and Remittance Remark Codes (RARC) Claim Status Codes, Group Codes, and Claim Status Category Codes due to the Affordable Care Act (ACA) Section 1104. Primarily CARC/RARC code combinations of existing edits are being expanded to accommodate new business rules per the ACA requirements.

     

    Effective immediately, some of these codes changes will be reported to providers via the 835-electronic remittance advice and the 277-claim status response. For more information on the ACA Operating Rules, please refer to the CAQH-CORE website at  www.CAQH.org > Core > Core Rules  > Code Combinations. Any additional questions should be directed to Provider Inquiry, Department of Community Health at ProviderSupport@michigan.gov.

    January 21, 2014:
    Attention ALL Providers: Due to a CHAMPS system issue, the Remittance Advice (RA) and 835 files for Pay Cycle 2 dated 01/09/2014 were only generated for denied and credited claims. Providers with paid claims will receive two different RAs and 835 files: 1) denied claims and/or credited amount; and 2) paid claims and any credit that is owed from the denied RA or 835 file. The Pay Cycle date in Champs Inquiry will show 01/09/2014 and 01/13/2014. The RA and 835 file date will continue to have the original date of 01/09/2014. MDCH has resolved all RAs and 835 files as well as checks and/or EFT payments.


    January 21, 2014:
    Attention OPH Providers:
    All paid claims with dates of service from 10/01/2013 through current will be adjusted with the newly loaded October APC software updates and should start to appear on pay cycle 5 (01/30/14). The adjusted claims can be identified by the claim note “APC Oct. 2013 quarterly updates”.
    Please review the following for information on how to verify the Adjustment Source of your claim.


    January 14, 2014
    :
    Attention OPH Providers: Effective January 1, 2014 CMS has implemented their guidelines regarding HCPCS code G0463 and MDCH will be following those CMS guidelines:  

    G0463 “(Hospital outpatient clinic visit for assessment and management of a patient), for hospital use only representing any clinic visit under the OPPS and to assign new HCPCS code G0463 to new APC 0634. This replaces CPT codes 99201 through 99205 and 99211 through 99215.”

     

    Please keep in mind that MDCH is currently adjudicating Outpatient Hospital claims with October 2013 quarter version APC software. MDCH, upon receipt of the CMS finalized January 2014 quarter APC software, will test and load the new software in late March. MDCH will claim adjust any claims that may be impacted by a delayed quarterly update implementation.
    The Medicare Addendum B is posted on the following CMS website:

    http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html

    January 09, 2014:
    Attention ALL Providers:
    Due to a CHAMPS system issue, the Remittance Advice (RA) and 835 files for Pay Cycle 2 dated 01/09/2014 were only generated for denied and credited claims. Providers with paid claims will receive two different RAs and 835 files: 1) denied claims and/or credited amount; and 2) paid claims and any credit that is owed from the denied RA or 835 file. MDCH expects to resolve all RAs and 835 files early next week as well as checks and/or EFT payments.

    December 30, 2013: 
    Attention ALL Providers: Due to a CHAMPS system issue, the Remittance Advice (RA) and 835 files for Pay Cycle 52 dated 12/26/2013 may not balance for some providers. MDCH will recreate new RAs and 835 files for providers that were affected. This does not effect all providers, so please review your RA. Please make sure to not double post the RA as this is a complete replacement for those providers affected.

    December 17, 2013Attention Community Mental Health Services Programs (CMHSPs): The psychiatric E&M codes (99201 – 99205 and 99211 – 99215) were added to the CWP and SED databases in August, effective for dates-of-service on/after January 1, 2013. As we are approaching the 12-month timely billing deadline for January services, we are providing this as a reminder that CMHSPs, enrolled as specialty providers for the CWP and SED, can now bill using these codes.  The databases are posted at http://www.michigan.gov/mdch/0,1607,7-132-2945_42542_42543_42546_42551-272724--,00.html. Select “Jan 2013” for the Serious Emotional Disturbance (SED) database and “Apr 2013” for the Children’s Waiver Services database. 

    December 17, 2013
    Attention ALL Providers: Providers are reminded that immunizations are covered services by Medicaid Health Plans (MHPs) when provided to health plan beneficiaries and should be billed to the MHPs. Immunization related claims for health plan beneficiaries will not be paid by fee for service. See the Medicaid Provider Manual, Medicaid Health Plan Chapter at: www.michigan.gov/medicaidproviders >> Policy and Forms >> Medicaid Provider Manual.


    December 13, 2013
    :  
    Attention ALL Providers: Due to Section 1104 of the Affordable Care Act (ACA), effective December 16, 2013, Electronic Funds Transfer (EFT) payments for Health Care Providers will be sent from the State of Michigan to respective financial institutions in the compliant CCD+ format.

    If you accept EFT payments and experience any issues with receiving payment, please contact provider support at 1-800-292-2550 or by email: ProviderSupport@michigan.gov

    December 09, 2013
    Attention Home Health Providers: In the case of a dually eligible beneficiary, if the primary insurance denies payment of home health services due to not meeting the primary insurance’s homebound requirement, Medicaid will cover services. Medicaid does not require a beneficiary to be entirely restricted to their home (i.e. “homebound”) to receive home health services. 

    When billing Medicaid secondary, a claim note is required stating “not covered by primary, as patient was not homebound." 

    December 04, 2013
    : Attention ALL Providers: We are experiencing connection errors with our Data Exchange Gateway (DEG). We are working to resolve this situation as quickly as possible. If you receive an error, please try again later.

    December 04, 2013
    : Attention ALL Providers: ICD-10 Testing is now available: 
    MDCH has created a survey-based tool that allows providers to review common medical scenarios and assign the ICD-10 diagnosis codes that they feel are appropriate. The survey is applicable to both medical professionals, such as physicians, nurse practitioners, and physician assistants, as well as coding and billing professionals. 

    The survey link and instructions have been posted at www.michigan.gov/5010ICD10/   >> ICD-10 Information >> Testing. 

     

    Should you have any questions, please feel free to contact our ICD-10 testing support team at MDCH-B2B-Testing@Michigan.gov. We look forward to testing with you!


    December 04, 2013
    Attention Nursing Facility Providers: Third Party Liability has identified beneficiaries who are residing in a Nursing Facility and who also have Medicare coverage and it was not reported on the claim, as outlined in MSA Policy Bulletin 12-01. Federal regulations require that all identifiable financial resources be utilized prior to the expenditure of Medicaid funds for health care services provided to Medicaid beneficiaries. Medicaid is considered the payer of last resort.

    Providers will receive a TPL recovery letter on January 6, 2014 (also available Archived Documents in CHAMPS), and providers have 30 days to adjust their paid claim or contact TPL if the beneficiary no longer has the coverage.  If no action is taken, TPL will void the claims identified in the letter which will result in an entire takeback of the paid claim. http://www.michigan.gov/documents/mdch/ClaimVoidReports_410671_7.pdf

    Note: When adjusting claim, please note in remarks “TPL  recovery, adding OTHER INSURANCE.”

     

     

     

     

     

     

     

     

    2013 

     

     

     

     

    2012

    Description: Description: 2011

    Description: Description: 2010

     

     


     

     

     

    Description: Description: Provider Tips

     

     

     

     

     

     

     

     

     


     

     

     

    Description: All Providers

    Description: Description: Ambulance

    Description: Description: Clinics

     

     

     

    Description: Description: Dental

    Description: Description: Home Health

    Description: Description: Hospice

     

     

     

    Description: Description: Hospital

    Description: Description: Nursing Facility

    Description: Description: Pharmacy and DME

     

     

     

    Description: Description: Physician 

    Description: Description: Private Duty Nursing

     

     

     

     


     

     

     

    All Providers

     

     

     

    October 17, 2013: Refund of Payment

    October 10, 2013: Benefits Monitoring Program (BMP):

    Benefits Monitoring Program

    Verifying BMP Eligibility

    Beneficiary Notification Letter Example

    Beneficiary Final Notification Letter Example

     

    MSA 1302 for Specialty Referrals


    October 01, 2013:
    MDCH-ICD10 Virtual Training *NEW

    June 14, 2013: Upper Peninsula Navigational Presentation  *Updated

    June 14, 2013: Upper Peninsula Professional Presentation 

     
    May 29, 2013:  Spendown Information 

    March 22, 2013: Medicaid 101 Training Sessions PowerPoint Presentation 

     

    March 07, 2013ICD-10 Virtual Training 

     

    December 11, 2012: ICD-10 Presentation 

     

    December 3, 2012: Medicare Part D Coverage of Benzodiazepines and Barbiturates 1/1/2013.

    As of January 1, 2013, Medicare Part D plans will begin covering benzodiazepines and barbiturates (i.e. barbiturates used in the treatment of epilepsy, cancer, or a chronic mental health disorder). For additional information on the Part D coverage changes, please visit the Michigan Medicaid website https://michigan.fhsc.com 

     

    October 8, 2012: How to Adjust a claim with OTHER INSURANCE 


    April 16, 2012:
      CHAMPS Navigational Presentation 

    March 21, 2012:  CHAMPS Navigational Presentation (billing/claims specific)

     

    October 26, 2011:  5010 Professional DDE

    October 26, 2011:  5010 Institutional DDE

    October 26, 2011:  5010 Dental DDE

    October 3, 2011:  Local CSHCS Office Contact Info

    December 1, 2010:  Incorrect Reporting of OI and Medicare on Medicaid Claims

    July 29, 2010:  NDC Format for Billing

    April 15, 2010:  Common Provider Rejections 


    January 15, 2010:
      PERM Audit Information
     

    August 27, 2008:  CMS 1500 Claim Completion Instructions 

    June 14, 2005:  Listserv Instructions- Updated 09.22.2009 

     

     

     

     


     

     

     

     

    Ambulance

     

     

     

     

    August 4, 2011:  Ambulance Billing Information and Reference Powerpoint 

     

    June 23, 2011:  Multiple Transports (Word)          Multiple Transports (PDF) 

    June 16, 2010:  2 Trips and Transport Codes 

     

     

     

     

     

     

     

     

     


     

     

     

     

    Clinics

     

     

     

     

    September 4, 2012: FQHC Common Rejections 

     

    May 8, 2012: LHD, RHC, FQHC, and THC- Instructions for pulling reconciliation data from CHAMPS

     

    May 8, 2012: Clinic Billing Tips 

     

     

     

     

     

     

     

     

     


     

     

     

     

    Dental

     

     

     

     

    March 12, 2012:  Dental Presentation 

     

    October 31, 2011:  Important 5010 Information

     

    October 31, 2011:  5010 Dental DDE 

     

    October 31, 2011:  5010 Failure to Comply WILL Result in Payment Delays 

     

    May 13, 2010:  Common Dental Reason and Remark Crosswalk 

     

    August 12, 2009:  CHAMPS, NPI, and General Updates PowerPoint 

     

    August 12, 2009:  Dental Billing Claim Examples: 

                               

                               Other Insurance Claim Example 

     

                               Replacement Claim Example  

     

                               Void Claim Example

     

     

     

     

     

     

     

     

     


     

     

     

     

    Home Health

     

     

     

     

    February 22, 2010: Home Health Billing Information and Reference Power Point

    February 22, 2010: CHAMPS Direct Data Entry (DDE) Billing Other Insurance Examples 

     

     

     

     

     

     

     

     

     


     

     

     

     

    Hospice

     

     

     

     

    September 12, 2011:  Hospice Top Pend/Rejection 

     

    September 8, 2011: Room & Board- Revenue code 0658 and 0659 do not require date of service on claim line. 

     

    June 8, 2011: Reminder: All Hospice claims must be reported with value code 61 and a valid CBSA code. 

     

    January 27, 2011: Hospice claims are being submitted with Value Code 66 to report the Patient Pay Amount (PPA).  Although this was acceptable under legacy, CHAMPS does not accept the use of Value Code 66 to report the PPA.  Per the National Uniform Billing Committee (NUBC), Value Code 66 is only to be used when reporting the Medicaid Spend Down Amount (Deductible).  Value Code D3, Patient Estimated Responsibility, must be used to report the PPA. 
     

    September 10, 2010: Hospice Membership Notices 

     

    June 28, 2010:  General Hospice Tips  

     

    April 29, 2009: Billing Information and Reference Powerpoint 

     

    April 29, 2009: Hospice Claim Examples:
                       Billing Theraputic Leave Days                  
                       
    Billing Hospital Leave Days                  
                       
    Billing Continuous Home Care                  
                       
    Billing Inpatient Respite Care                  
                       
    Billing General Inpatient Care-Non respite                  
                    
       Billing Physician Services                 
                       
    Reporting Patient Pay Amount                    
                      
     Other Insurance Denied                  
                       
    Other Insurance Terminated  

     

     

     


     

     

     

     

    Hospital

     

     

     

     

    April 08, 2013: How to Find Professional REV Codes 

     

    August 5, 2011: Inpatient Surgical/ ICD 9 Procedure code documentation requirements 

     

    June 20, 2011: Hysterectomy- When billing for a hysterectomy performed during a beneficiary's period of retroactive eligibility, please indicate in the Remarks section: "No consent not eligible on DOS, Retro MA. PT told prior to HYST unable to reproduce." 

     

    June 8, 2011: Outpatient Hospital Top Pend/Rejection 

     

    June 8, 2011: Inpatient Hospital Top Pend/ Rejection  

     

    June 6, 2011: Billing Tip: When beneficiary transfers from one hospital to another 

     

    June 2, 2011: Inpatient Hospital Rehab- Providers should report appropriate taxonomy code 273Y00000X, 283X00000X, or 283XC2000X ( not 282N00000X). 

      

    February 27, 2009: Update on Michigan Medicaid Hospital Audits 

     

    August 14, 2008: Tips for Billing Observation Room  

     

    August 4, 2008: Outpatient hospital providers are referred to the below links for more information regarding NDC: NDC  Format For Billing  NDC Frequently Asked Questions  and  Letter L 08-14.  

     

     

     


     

     

     

     

    Nursing Facility

     

     

     

     

    March 12, 2012: Nursing Facility Presentation  

     

    July 18, 2011: Hospital Swing Beds are to report Type of Bill (TOB) as 018x

     

    July 1, 2011: All Nursing facility providers must report Medicare information if the beneficiary has active Medicare on file, even if Medicare benefit exhausted (billing after 100-day benefit period) or billing for non-skilled level of care. 

     

    June 30, 2011: Outpatient County Medical Care Facilities- Report Type of Bill (TOB) as 23X when billing for therapies.

     

    June 23, 2011: Report Covered, Non-Covered and Co-Ins Days based on Primary insurance with Value code 80, 81 and 82

     

    June 23, 2011: Exhausted Medicare Part A Benefits - Report Occurrence Code A3 and the last date patient had Medicare Part A and report Medicare information with appropriate CARC/Reason Code 119 or 96 and reason why it was not covered by Medicare.

     

    June 23, 2011: Total of units for Room and Board and Leave Days on line level should be equal with number of days reported on FROM and TO Date (UB04 - Form Locator 6).

     

    May 25, 2011: Reporting Leave Days - When billing leave days, FROM/ TO Dates and quantity must be reported on service line.

     

    May 25, 2011: All Nursing facility providers should report Medicare information if the beneficiary has active Medicare on file, even if they are Medicaid only (non Medicare certified bed) facilities.

     

     

     


     

     

     

     

    Pharmacy/DME

     

     

     

     

    March 20, 2013: Effective April 1, 2013, Health Care Procedure Codes (HCPCS) E2373, K0733 and L3600 fees will be reduced below Medicare fees to align with Medicaid policy referenced in the Medicaid Provider Manual, Medical Supplier Chapter, Section 1.7.H.  A formal announcement of these changes will not be indicated in a policy bulletin.  Please refer to policy and the Medical Supplier Database for standards of coverage and code parameters.  The new reimbursement rates are as follows:

     

     

    HCPCS Code:                           Rate Effective 04/01/13:

    E2373                                       $560.10

    K0733                                       $20.75

    L3600                                       $52.43

     

     

    December 3, 2012: Medicare Part D Coverage of Benzodiazepines and Barbiturates 1/1/2013.

    As of January 1, 2013, Medicare Part D plans will begin covering benzodiazepines and barbiturates (i.e. barbiturates used in the treatment of epilepsy, cancer, or a chronic mental health disorder). For additional information on the Part D coverage changes, please visit the Michigan Medicaid website https://michigan.fhsc.com 

     

    May 13, 2010:  Common DME Reason and Remark Crosswalk 

     

     

     


     

     

     

     

    Physician

     

     

     

     

    February 25, 2013Immunizations Administration and Preventive Medicine Services. 

      

    June 14, 2011: Physician/Professional Billing Power Point   

     

    June 17, 2010: General Physician Tips 

     

    January 27, 2010: CHAMPS Direct Data Entry (DDE) billing Other Insurance examples -  *Updated 10/12/10 

     

     

     

     


     

     

     

     

    Private Duty Nursing

     

     

     

     

    September 14, 2010: IMPORTANT NOTICE:  Effective October 1, 2010, the Michigan Department of Community Health (MDCH) will require Private Duty Nursing (PDN) providers to bill HCPCS codes S9123 and S9124 in one-hour increments as required in the 2010 HCPCS coding book. PDN services are prior authorized in hours. Therefore, when billing for services, the total number of hours billed - whether with S9123 and/or S9124 - must not exceed the total number authorized for that month. Since whole hours of care are authorized, only those hours of care that entail a full hour of care may be billed.     
    Please Note:  Authorization letters for the month of October will authorize care in units but the quantity will reflect the number of hours approved for the month.  One unit = one hour.  Refer to Bulletin MSA 10-35 for further information.  

     

    August 10, 2010: PDN Agency Presentation 

     

    September 10, 2009: Agency Billing Information and Reference Powerpoint 
                                          (CHAMPS information included)

     

    September 10, 2009: Independent Nurse Billing Information and Reference Powerpoint   *Updated 09/01/10 
                                          (CHAMPS information included)

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     
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