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This page is intended for Dental providers who are new to the Medicaid program or are looking for resource materials.  This page contains information needed to enroll and submit dental claims to the Michigan Department of Health and Human Services (MDHHS) for Medicaid and Children’s Special Health Care Services (CSHCS). It also contains information about how claims are processed and how providers are notified of MDHHS actions.

To access a resource click on the preferred file hyperlink.

New to Michigan Medicaid Dental? Review our Dental Provider Beginner Guide

 

Frequently Asked Questions

Register for MiLogin and Request CHAMPS Access

All providers who serve Michigan Medicaid beneficiaries, including providers participating in Medicaid Health Plans (MHP) and Dental Health Plans provider networks, must be screened and enrolled in the Community Health Automated Medicaid Processing System (CHAMPS).  

Click here for an overview and CHAMPS resources to start the enrollment process

 

CHAMPS Provider Contact Information

MDHHS utilizes provider email address information entered in the CHAMPS provider enrollment application to communicate with providers. Providers are responsible for maintaining accurate and valid email address information within their CHAMPS provider enrollment information. If email information is out of date or incorrect enrolled providers will want to modify their enrollment information and submit it for approval.

For instructions on how to update or modify email addresses reference the Provider Enrollment webpage step-by-step enrollment guide resources.

Verification 

Eligibility

A person eligible for and/or receiving services under the MI Medicaid Program can be verified using the CHAMPS member search function. The Member tab or function in CHAMPS allows access for users to verify eligibility for a member via the web-based screens or by submitting a 270-electronic request. Providers need to utilize the Benefit Plan ID(s) indicated in the eligibility response to determine coverage for a specific date of service.

Reference for Dates of Service Prior to April 2023
Coding

Is that code covered? Access the Medicaid Code and Rate Reference Tool >>External Links Quick Reference

  • Utilizing the Medicaid Code and Rate Reference Tool
  • Medicaid Dental Fee Screens
  • Dental Frequency Verification (DFV)
    • As of June 1, 2024, as outlined in MMP 24-14 the Dental Frequency Verification (DFV) will be performed by Dental Providers within CHAMPS. It is the provider’s responsibility to verify the five-year rule before providing service and retain documentation of the screenshot in CHAMPS and the date of the response in the beneficiary’s dental record. Failure to complete the verification process may result in denied claims. Frequency verification approval does not guarantee beneficiary eligibility or payment. Before rendering services, the provider is responsible for verifying the beneficiary's Medicaid eligibility on each date of service.
  • Prior Authorization

Claim Submission

All claims submitted and accepted are processed through CHAMPS. Paper claims are scanned and converted to the same file format as claims submitted electronically. Claims processed through CHAMPS are edited for many parameters, including provider and beneficiary eligibility, procedure validity, claim duplication, frequency limitations for services, and a combination of service edits. Electronic claims received by Wednesday may be processed as early as the next weekly cycle. MDHHS encourages providers to send claims electronically. 

Additional Billing Resources

After the Claim Has Processed

Once claims have been submitted and processed through CHAMPS, an electronic health care claim payment/advice (ASC X12N 835 5010) is sent to the designated service bureau for providers choosing an electronic RA. The CHAMPS RA is also available to providers online or is sent to providers via paper if requested through the Provider Enrollment Subsystem. 

Electronic Funds Transfer (EFT) is the method of direct deposit of State of Michigan payments into a provider’s bank account. This replaces a paper warrant. To initiate an EFT, visit the SIGMA website. 

Additional Resources 
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Need More Help? Provider Support is Here

If you are thinking about becoming an enrolled Medicaid dental provider or are currently enrolled and are interested in having an MDHHS Provider Consultant contact you for 1-on-1 conversation, please submit your request using the link below. Once the information is submitted it will be logged and forwarded to a Provider Consultant that specializes in your field. The Provider Consultant will then, contact you to make the necessary arrangements. These 1-on-1 sessions are available virtually or in person and are intended to provide specialized training for providers. 
1-on-1 Appointment Request