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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: CHAMPS

Description: Description: Policy Bulletins

Description: Description: ICD10

 

 

 

Description: Description: Email Provider Support

 

Description: Description: Phone Menu for Provider Support

 

 

 

 

 

 

 

 

 


 

 

 

Description: Description: Biller B Aware

 

 

 

 

 

 

 

 

 

April 24, 2015: Attention ALL Providers: Due to a system error, some providers who receive Electronic Funds Transfer (EFT) payments may have only received an 835 file and remittance advice (RA) showing denied claims for pay cycle 16 (4/23/15). Affected providers did receive their EFT payment but payment information was missing from the 835 file and RA. MDHHS has now completed 835 files and RAs for the paid claims information.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov

April 20, 2015
:
System Outage: Due to CHAMPS system maintenance, the CHAMPS system downtime will be down between 7:00 PM Friday, April 24, 2015 and 2:00 AM on Saturday, April 25, 2015. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

April 17, 2015:
  Attention Adult Home Help Services: MSA L-Letter 15-22 was inadvertently mailed to all Adult Home Help Services Providers. This L-Letter only pertains to Adult Home Help Services providers in the current MI Health Link demonstration counties:  Alger, Baraga, Barry, Berrien, Branch, Calhoun, Cass, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Kalamazoo, Keweenaw, Luce, Mackinac, Macomb, Marquette, Menominee, Ontonagon, Schoolcraft, St. Joseph, Van Buren and Wayne. If you are an Adult Home Help Services Provider not within one of these demonstration counties, please disregard this L-Letter as you are not affected by this change.

April 15, 2015
:
Attention ALL Providers: The latest batch of MDCH Quarterly Newborn Recoveries is currently being processed. This batch includes fee for service claims for newborns that were retroactively enrolled into a Medicaid Health Plan. Please note, as with previous quarterly newborn take backs, claims must be submitted to the Medicaid Health Plans within 60 days from the Medicaid Remittance Advice date. Please review the following for information on how to verify the Adjustment Source of your claim.

Providers with further questions can contact provider support by phone1-800-292-2550 or by email ProviderSupport@michigan.gov


April 07, 2015
: System Outage: Due to system maintenance, the CHAMPS system will be down between 6:00 PM Saturday, April 11th thru 6:00 AM Sunday, April 12th, 2015. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

March 31, 2015
: Attention Nursing Facility and Waiver Agency Providers: UPDATE: In regards to the message posted March 10, 2015 related to the Level of Care Determination (LOCD) tool, the CHAMPS system issue with adding the beneficiary identification number to a LOCD tool where the beneficiary’s active benefit plan was other than Medicaid Fee for Service (FFS) has been corrected. For those LOCD’s affected, providers are now able to go back into the LOCD and add the beneficiary ID number.

March 31, 2015
: Attention ALL Providers: As part of the April 24th update within CHAMPS, MDCH will no longer report Claim Adjustment Reason Codes (CARC) with a zero dollar amount on the electronic 835 and Remittance Advice. Claims denied for multiple CARC’s will only have one CARC reported at the line level but will have all Remittance Advice Remark Codes (RARC) reported. Providers are encouraged to review their internal systems to see if changes are needed for automatic posting of remittance advices.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov

March 27, 2015: Attention ALL Providers: Due to the State of Michigan network maintenance activities, the following periodic outages may cause a delay for electronic files:

Core 270/271 Real-time transactions:
Saturday March 28, 2015 5:00 PM - 9:00 pm EST
Sunday March 29, 2015  Beginning at 6:00 AM EST and ending Monday, March 30, 2015 at 2:00 AM EST

Batch 270/271: There may be a delay in receiving batch 271 response files for 270 files submitted after 7:00 PM EST, Friday March 27, 2015.

We apologize for this inconvenience. Please contact AutomatedBilling@michigan.gov with questions or concerns.


March 24, 2015
: Attention Outpatient Hospital Providers:
 All Outpatient Hospital claims with dates of service on or after 1/01/2015 will be adjusted or resurrected to process using the newly loaded January APC software updates and will begin to appear on pay cycle 13 (4/02/15 remittance advice). Adjusted claims can be identified by the claim note “APC Jan 2015 quarterly updates.” For further information, providers can review how to verify the Adjustment Source of your claim.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov

March 16, 2015:
Attention Professional Providers: MDCH would like to remind providers of current Medicaid policy as outlined within the Medicaid Provider Manual, Billing & Reimbursement for Professionals Chapter, Section 6.4 Ancillary Medical Services, “Immunizations must be reported using the administration fee code(s) and the code identifying the type of vaccine given”. In April 2015, MDCH will begin voiding paid claims that reported the administration code without the corresponding immunization code. Medicare primary claims will not be included in these voids.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov

March 10, 2015
: System Outage: Due to system maintenance, CHAMPS will be down between 6:00 PM Saturday, March 14, 2015 thru 6:00 AM Sunday, March 15, 2015.  This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

March 10, 2015:
Attention Nursing Facility and Waiver Agency Providers UPDATE: When attempting to add the beneficiary identification number to a Level of Care Determination (LOCD) tool where there is eligibility other than MA, MA-HMP or Spend-down, the following error code is once again being displayed: “LOCD may not be conducted for private pay individual; MA not active as of the date of this LOCD.” Until the issue is corrected, MDCH asks providers to continue to conduct LOCD as outlined in current policy.

March 05, 2015
:
System Outage: Due to CHAMPS interim release deployment, the CHAMPS system will be down between 7:00 PM and 11:00 PM on Friday, March 6th, 2015. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

February 24, 2015:
System Outage: Due to CHAMPS system maintenance, the CHAMPS system will be down between 7:00 PM Friday, February 27, 2015 through 2:00 AM on Saturday, February 28, 2015 with the exception of Core 270/271 real-time transactions which will be down between 7:00 PM and 11:00 PM on Friday, February 27, 2015. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

February 11, 2015
:
System Outage: Due to system maintenance, the CHAMPS system will be down between 6:00 PM Saturday, February 14, 2015 through 6:00 AM Sunday, February 15, 2015. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

February 04, 2015:
Attention Home Health Providers: Home Health Agencies are reminded that in accordance with the Medicaid Provider Manual,  HCPCS code G0154 (Direct skilled Nursing Services of a Licensed Nurse in the Home Health Setting) cannot be billed when a Medicaid beneficiary is receiving private duty nursing (PDN) services (HCPCS code T1000).  Specifically, the Medicaid Provider Manual, Home Health Chapter, Section 6 states; “Intermittent nurse visits are not covered for a beneficiary receiving Private Duty Nursing Services.” When PDN is authorized, the expectation is that all skilled nursing services will be rendered by the PDN, and therefore, intermittent nurse visits by a home health agency would be duplicative. An enhancement to CHAMPS is under development to prevent the ability to bill HCPCS code G0154 when PDN has been authorized.  Recoveries will be initiated to address this duplication of service.

February 04, 2015:
Attention Nursing Facility and Waiver Agency Providers: UPDATE: In regards to the message posted January 8, 2015 related to the Level of Care Determination (LOCD) tool, the CHAMPS system issue with adding the beneficiary identification number to a LOCD tool where the beneficiary’s active benefit plan was other than Medicaid Fee for Service (FFS) has been corrected. For those LOCD’s affected, providers are now able to go back into the LOCD and add the beneficiary ID number.

February 03, 2015:
Attention Vision Providers: Providers who order services must be listed correctly on the DCH-0893 submitted to the MDCH Vendor (currently Classic Optical). Box 3 of the DCH-0893 requires the provider to enter the Ordering Provider NPI Number. Providers must enter the individual NPI of the provider that is ordering the glasses/lenses or other equipment from Classic Optical. Please refer to policy bulletins MSA 12-55 and MSA 13-17 for further information.

Vision Providers with further questions can contact Provider Support by phone 1-800-292-2550 or by email ProviderSupport@michigan.gov.

January 30, 2015:
Attention Ambulance Providers: Effective for claims submitted on and after February 1, 2015, MDCH is implementing new claim submission requirements that apply to claims for multiple ambulance transports rendered to the same beneficiary on the same date of service.  Multiple transports provided on the same date of service must be reported on separate lines and include the origin and destination modifier with both the base rate and mileage procedure codes. Modifier 22 is no longer required. The use of modifier 22 will result in claim suspension and may delay in resolution. Providers are encouraged to review MSA 14-65 for further information. 

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov.


January 28, 2015
:
Attention ALL Providers: Effective January 5, 2015, the United States Postal Service (USPS) announced that the standard for first class mail delivery has changed from 1-2 days to 2-3 days for all regions of Michigan. MDCH will make every effort to mail paper warrants and paper remittance advices as early as possible. However, this change in the standard for the first class mail delivery may increase the likelihood that some providers may experience a delay in receiving paper warrants and paper remittance advices.

MDCH would like to encourage providers to sign up for Electronic Funds Transfer (EFT) and receive electronic remittance advices by end dating the paper RA location address within their CHAMPS enrollment information.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov


January 28, 2015
: Attention Professional Providers: As part of the December 12, 2014 CHAMPS update, there is an update to the Children’s Special Health Care Services (CSHCS) editing of claims. For professional claims, if the rendering provider NPI is enrolled as a Nurse Practitioner or Physician Assistant, the rendering provider NPI does not need to be authorized by CSHCS if the referring, ordering, or supervising NPI is an authorized provider within the client file. These claims will no longer deny for the rendering NPI not being authorized.

January 21, 2015
:
Attention ALL Providers: System maintenance for the Data Exchange Gateway (DEG) is scheduled for Saturday, January 24, 2015. The scheduled down time is between 8:00 A.M. and 5:00 P.M. There will also be a brief period of down time on Sunday, January 25, 2015 between 9:00 A.M. and 12:00 P.M.  Please do not submit any files during this time period.

January 21, 2015
:
Attention ALL Providers: The latest batch of MDCH Quarterly Newborn Recoveries is currently being processed. This batch includes fee for service claims for newborns that were retroactively enrolled into a Medicaid Health Plan. Please note, as with previous quarterly newborn take backs, claims must be submitted to the Medicaid Health Plans within 60 days from the Medicaid Remittance Advice date. Please review the following for information on how to verify the Adjustment Source of your claim.

Providers with further questions can contact provider support by phone: 1-800-292-2550 or by email:
ProviderSupport@michigan.gov

January 15, 2015
:
Attention Outpatient Hospital Providers: CMS has approved G0463 as a payable HCPCS code within the Plan First benefit plan. The CHAMPS system has recently been updated to reflect this change. For dates of service on or after January 1, 2014, MDCH will resurrect Outpatient Hospital claims billing HCPCS code G0463 that were denied due to the beneficiary being enrolled with the Plan First benefit plan on the date of service. The resurrected claims will begin to appear on pay cycle 4 dated January 29, 2015 and identified with the claim note “OPH Claims with G0463 proc. code and Plan First benefit plan”.

Providers with further question can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@michigan.gov

January 08, 2015
:
Attention Nursing Facility and Waiver Agency Providers: After the CHAMPS December 12, 2014 update, when Nursing Facility and Waiver Agencies attempt to add the beneficiary identification number to a Level of Care Determination (LOCD) tool and the beneficiary’s active benefit plan is other than Medicaid Fee for Service (FFS), the following error code is displayed: “LOCD may not be conducted for private pay individual; MA not active as of the date of this LOCD.” Until the issue is corrected, MDCH asks providers to continue to conduct LOCD as outlined in current policy.

Providers with further questions can contact Provider Support by phone 1-800-292-2550 or by email ProviderSupport@michigan.gov.

Janaury 6, 2015:
System Outage: Due to system maintenance, the CHAMPS system will be down between 6:00 AM Saturday, January 10th, 2015 through 9:00 PM Sunday, January 11th, 2015 with the exception of Core 270/271 real-time transactions which will be down between 6:00 AM and 10:00 AM on Saturday January 10th, 2015. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

December 23, 2014
: System Outage: Due to CHAMPS system maintenance, the CHAMPS system will be down Wednesday, December 31, 2014 between 6:00 PM and 11:59 PM EST. Service will resume at 12:01 AM on Thursday, January 1, 2015. This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may case.

December 18, 2014:
Attention ALL Providers: As part of the December 12, 2014 CHAMPS update, there is an update to the Children’s Special Health Care Services (CSHCS) editing on claims. For professional claims, if the rendering provider NPI is a physician provider type and has one of the following specialties within their enrollment information: Anesthesiology, Pathology, Radiology, MRI or CAT scan; the rendering provider NPI does not need to be authorized by CSHCS if the referring or ordering or supervising NPI is an authorized provider on the client file. These claims will no longer deny for the rendering NPI not being authorized.

December 17, 2014: Attention Nursing Facility Providers:  UPDATE: In regards to the message posted December 12, 2014 related to Medicare Advantage Plan Coinsurance claims, Third Party Liability is in the process of identifying and adding the Medicare Advantage Plan Coinsurance rates.  Until this process is complete, if a provider chooses to adjust an incorrectly paid claim, and it pays the same, please understand that the rate may not yet be verified and/or loaded.

December 15, 2014
:
Attention Inpatient Hospital Providers: Effective for discharge dates on or after January 1, 2015, claims that fail the newborn claim reporting edits for newborn priority (type of) admission or visit and newborn birth weight will be denied. Providers are encouraged to review current MSA policy bulletins 14-34 and 14-59 for reporting information. Claims denied for incorrect type of admission can be identified with claim adjustment reason code (CARC) 16 and remittance advice remark code (RARC) MA42 or MA41. Claims denied for incorrect, invalid or non-reporting of the newborn birth weight can be identified with CARC 16 and RARC N207.

Providers with further questions can contact provider support by phone 1-800-292-2550 or by email ProviderSupport@michigan.gov


December 15, 2014
:
Attention Outpatient Hospital Providers: MDCH has resurrected Outpatient Hospital claims billing the L1 modifier for dates of service 1/1/14 which adjudicated on or after July 2014 remittance advice date. These claims can be identified with the claim note “APC July 2014 quarterly updates. Modifier L1 resurrects” and will begin processing on pay cycle 52 (12/23/14 remittance advice).

How to verify the adjustment source of your claim

December 15, 2014
: Attention ALL Providers: Health Savings Accounts (HSAs) are not considered to be commercial health insurance. Therefore, this type of asset does not need to be reported to Third Party Liability (TPL). Since these are counted as “assets,” the beneficiary should report this to their DHS worker.

December 12, 2014
: Attention Nursing Facility Providers: As part of the December 12, 2014 CHAMPS system update, Medicare Advantage Plans Coinsurance claims that do not mirror Medicare Fee-for- Service will correctly adjudicate. To ensure proper adjudication of these Medicare Advantage Plan Coinsurance claims, other insurance information must be reported as listed in the member’s Third Part Liability (TPL) file under Medicare Part C.

December 11, 2014
: Attention ALL Providers: This is a reminder that effective December 12, 2014, EZ Link portal and Fax numbers will no longer be an available option to submit claim documentation for the following: Consent Forms, Medical Documentation, and Predictive Modeling.  Please refer to MSA Policy Bulletin 14-06 for more information and instructions on the Documental Management Portal (DMP) tool within CHAMPS for electronically submitting supporting documentation to Medicaid for electronic claims.

December 09, 2014
: System Outage: Due to CHAMPS system maintenance, the CHAMPS system will be down between 2:00 PM on Saturday, December 13th 2014 to 6:00 AM on Sunday, December 14th 2014. This outage will affect CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

December 03, 2014
: Attention ALL Providers: System maintenance for the Data Exchange Gateway (DEG) is scheduled for Saturday, December 13, 2014. The scheduled down time is between 9:00 A.M. and 5:00 P.M. Please do not submit any files during this period.

November 21, 2014
: Attention Dental and Professional Providers: Beginning January 1, 2015 MDCH will begin enforcing claim processing edits on payments for provider services rendered in appropriate places of service. Claims denied for inappropriate place of service can be identified by claim adjustment reason code (CARC) 5 and remittance advice remark code (RARC) M77.
Providers are encouraged to refer to appropriate provider-specific chapters of the Medicaid Provider Manual for further information.

November 21, 2014:
  Attention ALL Providers: System maintenance for the Data Exchange Gateway (DEG) is scheduled for Sunday, December 7, 2014. The scheduled down time is between 8:00 A.M. and 12:00 P.M. Please do not submit any files during this time period.

November 21, 2014
: Attention Hearing Providers:  MDCH is requesting input regarding your interest in the development of a virtual training specific to the needs of hearing providers. Please respond to this survey link by Friday December 19, 2014. 

November 18, 2014
: System Outage: Due to CHAMPS system maintenance, the CHAMPS system will be unavailable between 6:00 AM Friday, November 28th 2014 to 6:00PM on Saturday, November 29th 2014 with the exception of Core 270/271 real-time transactions which will be down between 6:00 AM and 10:00 AM on Friday November 28th. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience this may cause.

November 12, 2014: Attention ALL Providers:  A tutorial containing screenshots has been created to provide clarification in determining beneficiary participation with Michigan Medicaid Healthy Michigan Plan (MA-HMP), Michigan Medicaid Healthy Michigan Managed Care (MA-HMP-MC), or a Prepaid Inpatient Health Plan (PIHP).  Once beneficiary participation is identified, providers must contact the appropriate plan for any additional assistance or questions. View the tutorial here!

November 05, 2014: UPDATE: In regards to the message posted on September 23, 2014 for ALL Providers:  MDCH Third Party Liability (TPL) will no longer add, update, or term records to match web-DENIS.  Providers are asked to please contact Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) for any questions related to loaded coverage. If CHAMPS and/or web-DENIS indicate active BCBSM or BCN coverage, please follow all Coordination of Benefits (COB) rules when submitting Medicaid claims.

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

 

 

 

 

 

 

 

 2014

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

 

 

 

April 08, 2015: CSHCS Provider Information Page

March 19, 2015
: ICD-10 Virtual Presentation

March 10, 2015: How to Adjust a claim with OTHER INSURANCE *UPDATED


March 10, 2015:
Refund of Payment

March 10, 2015: 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

June 14, 2013: Upper Peninsula Professional Presentation 

 

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 

 


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 3, 2011:  Local CSHCS Office Contact Info

January 15, 2010:  PERM Audit Information


August 27, 2008:
  CMS 1500 Claim Completion Instructions 

June 14, 2005:  Listserv Instructions- Updated 09.22.2009 

 

 

 


 

 

 

 

Ambulance

 

 

 

 

The Ambulance section is in the process of being updated. Please email ProviderOutreach@michigan.gov if you have suggestions! Thank you for your patience.  

 

 

 

 

 

 

 

 

 


 

 

 

 

Clinics

 

 

 

 

February 24, 2015: Clinic Billing Tips 

 

 

 

 

 

 

 

 

 


 

 

 

 

Dental

 

 

 

 

The Dental section is in the process of being updated. Please email ProviderOutreach@michigan.gov if you have suggestions! Thank you for your patience. 

 

 

 

 

 

 

 

 

 


 

 

 

 

Home Health

 

 

 

 

The Home Health section is in the process of being updated. Please email ProviderOutreach@michigan.gov if you have suggestions! Thank you for your patience. 

 

 

 

 

 

 

 

 

 


 

 

 

 

Hospice

 

 

 

 

The Hospice section is in the process of being updated. Please email ProviderOutreach@michigan.gov if you have suggestions! Thank you for your patience. 

 

 

 


 

 

 

 

Hospital

 

 

 

 

March 10, 2015: Inpatient Surgical/ ICD 9 Procedure code documentation requirements

April 08, 2013
: How to Find Professional REV Codes
 

  

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

 

 

 


 

 

 

 

Nursing Facility

 

 

 

 

Nursing Facility Historical Provider Tips

 

 

 


 

 

 

 

Pharmacy/DME

 

 

 

 

The Pharmacy/DME section is in the process of being updated. Please email ProviderOutreach@michigan.gov if you have suggestions! Thank you for your patience. 

 

 

 


 

 

 

 

Physician

 

 

 

 

March 10, 2015Immunizations Administration and Preventive Medicine Services. 

 

 

 


 

 

 

 

Private Duty Nursing

 

 

 

 

The PDN section is in the process of being updated. Please email ProviderOutreach@michigan.gov if you have suggestions! Thank you for your patience. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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