Eligibility Verification System (EVS) Topics:

• Benefit Plans
• CHAMPS
• webDENIS
• MPHI
• AVRS: Discontinued 09/29/09
• Verifying Eligibility with the mihealth card
• EVS Search methods
• Information available on the EVS
• Eligibility Policy
• Need more information

BENEFIT PLANS:

• Providers will now need to utilize the Benefit Plan ID(s) indicated in the eligibility response to determine a beneficiary's program coverage and related covered services for a specific date of service. 

• Benefit Plan data is assigned by the CHAMPS Eligibility and Enrollment (EE) Subsystem based on the source of the data (e.g., Medicaid, CSHCS, etc.) and program assignment factors (e.g., scope/coverage codes, level of care codes, etc.).

• Benefit Plan ID table:  Click Here  or See  MSA Policy Bulletin 09-46  

The following Eligibility Verification Systems (EVS) are available for MI Medicaid Providers to verify eligibility for Medicaid, CSHCS, MOMS and ABW:

CHAMPS - Eligibility and Enrollment (EE) Subsystem:

• Online Eligibility Inquiry is now available for Providers. 
• To access the CHAMPS system you must log onto https://sso.state.mi.us
• For instructions on how to obtain a user ID/password and to subscribe to CHAMPS please click here: SSO Instructions  
• Go to the 'Provider Portal', then 'Member' section, then click on the 'Eligibility Inquiry' hyperlink.
• See Policy Bulletin  MSA 09-30  and MSA 09-46  for more information.
• Response Examples: Coming soon

• web-DENIS is BCBSM's secure browser-based internet site for eligibility verification.
• Eligibility information for Medicaid, CSHCS, MOMS, ABW, and MIChild is available including Pending Eligibility.
• Providers can also print the eligibility response to use for documentation of coverage. 
• ANSI, ASC X12N 270/271 transaction is also available. Contact BCBSM at 1- 800-542-0945 and/or  click here for more information .
• Available to MI Medicaid Providers free of charge. 

To obtain access into web-DENIS, please review the following instructions:

• Participating BCBSM Providers with current access to web-DENIS:  Click Here  
• Participating and Non-Participating BCBSM Providers without access to web-DENIS:  Click here

webDENIS Response Examples: Coming soon

Need more information:

• Provider Letter (L 05-25):  Click Here

• MI Healthplan Benefits Website: This website allows users to submit individual or multiple eligibility inquiries (up to 15 at a time) using a single date of service (DOS) or DOS span. The following website contains an access enrollment form: https://healthplanbenefits.mihealth.org  >> Enrollment Form
• X12 270/271 (Real time) HIPAA Transaction: This transaction allows users to submit individual eligibility requests at any time using a single DOS or DOS span. This option provides an immediate real time response to each eligibility request.  For more information: Click Here
• X12 270/271 (Batch) HIPAA Transaction: This transaction allows users to submit a batch file at any time and receive a response file within 24 hours.  For more information: Click Here

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Automated Voice Response System (AVRS): 1-888-696-3510

• AVRS will no longer be availabe effective September 29th, 2009.
• Providers without internet access can contact  Provider Inquiry at 1-800-292-2550 to verify eligibility.

Verifying Eligibility with the  mihealth card :

• Use the beneficiary ID number search method  and "Key-In" the ID number (located on the front of the mihealth card ).
• "Swipe" the mihealth card using Magnetic swipe technology available thru  Emdeon .
• Additional  search methods  are available if a beneficiary does not have the mihealth card. 

Use one of the following search methods to find and access a beneficiary's eligibility information on the EVS: 

1. Beneficiary ID number or Client Identification Number (CIN) (MIChild Inquiries only)

2. Beneficiary social security number and date of birth.

3. Beneficiary name and social security number (or date of birth).

Information available on the EVS

• Benefit Plan  data for the date of service, which is assigned by the Eligibility Subsystem based on the source of the data (e.g., Medicaid, CSHCS, and MOMS) and program assignment factors (e.g., scope/coverage codes, Level of Care [LOC] codes, etc.). Providers will need to utilize the Benefit Plan ID(s) indicated in the response to determine a beneficiary's program coverage and related covered services for a specific date of service.
• LOC information (including the LOC code), Source Provider ID (supplied through the Department of Human Services[DHS]), National Provider Identifier (NPI), provider name, telephone number, address, and patient pay amount, if applicable. 
• Medicaid Health Plan (MHP) Primary Care Physician (PCP), including the PCP name, telephone number, and NPI. (Note: Data provided only if the date of service is the current date.)
• Third-Party Liability (TPL), including the payer name, payer ID, coverage type code, group number, policy number, and policy holder ID.  Note: If the TPL listed is no longer active or if is not being reported in the response, please contact Provider Inquiry at 1-800-292-2550 or e-mail   TPL_Health@michigan.gov .
• CSHCS restriction data, including qualifying diagnosis code(s) and authorized provider list if the provider submitting the inquiry is authorized for the date of service.
• Other information: Transaction date (when the data was applied to the Eligibility Subsystem), current county of residence, DHS case number, DHS worker load number, and DHS local office home number.
• Pending Eligibility

• Provider Manual: Click Here  
• Go to the Beneficiary Eligibility Chapter: Section 3 - Verifying Beneficiary Eligibility

Contact Provider Inquiry:

• MDCH/Provider Inquiry
  P.O. Box 30731
  Lansing, MI 48909-8231
• Phone: 1-800-292-2550
• E-mail: ProviderSupport@michigan.gov  

The mihealth card:

• Click here