Up and Coming Initiatives

New Medicare ID Cards Project

Modernizing Continuum of Care (MCC) 

 

             


Provider Tips

 

Provider Tips Archive



February 8, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) has identified an issue with Patient Pay Amount (PPA) not displaying within the CHAMPS member eligibility screen. Until this is resolved providers should report the known monthly PPA on their claim or if unknown contact the MDHHS county worker. 

It is not necessary for providers to contact Provider Support to have these records corrected. Additional MCC resources can be found on the MCC portion of this webpage.

February 7, 2018: Attention ALL Providers: The Centers for Medicare & Medicaid Services (CMS) will remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new unique Medicare Beneficiary Identifier (MBI) will replace the current Health Insurance Claim Number (HICN) on the new Medicare cards. CMS will begin mailing new cards to people in April 2018.

Providers systems and business processes must be ready to accept the new MBI number by April 2018 for transactions, such as billing, claim status, eligibility status, and interactions, with the CMS Medicare Administrative Contractor (MAC) contact centers.

There will be a transition period when providers can use either the HICN or the MBI to exchange data and information with CMS. The transition period will start April 1, 2018, and run through December 31, 2019. However, providers systems must be ready to accept the new MBI by April 1, 2018.

Providers should refer to the CMS Fact Sheet to ensure they are prepared to receive the MBI: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TransitiontoNewMedicareNumbersandCards-909365.pdf

Learn more about the CMS New Medicare Card Project: https://www.cms.gov/medicare/new-medicare-card/nmc-home.html

February 6, 2018 and January 16, 2018: Attention ALL Providers: In preparation for the CMS New Medicare Card project, beginning in February 2018, Third Party Liability (TPL) will be removing the Social Security Number (SSN) or policy number from the monthly Pending Void Report when the payer is Medicare.  The appropriate policy number per beneficiary will be available directly in CHAMPS if needed. 

Learn more about the CMS New Medicare Card Project: https://www.cms.gov/medicare/new-medicare-card/nmc-home.html

Instructions on how to verify other insurance information within CHAMPS: http://www.michigan.gov/mdhhs/0,5885,7-339-71547_4860-344079--,00.html

Providers with further questions regarding the TPL void report can contact provider support by phone 1-800-292-2550 or by email ProviderSupport@Michigan.gov

February 6, 2018: Attention ALL Providers: On January 16, 2018, the Michigan Department of Health and Human Services (MDHHS) removed the associated age restriction of 0-18 years to diagnosis code F98.8- Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence and the associated age range. Claims billed prior to the CHAMPS system being updated may have been affected if the beneficiary was not within the age range of 0-18 years. Providers should rebill or adjust any affected claims for correct processing.

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

February 5, 2018: Attention All Providers: The Michigan Department of Health and Human Services (MDHHS) would like to notify providers of the upcoming CMS New Medicare Card Open Forum on Tuesday, February 6, 2018, 2:00-3:00 PM EST.

CMS’s Office of Information Technology (OIT) will host a Special Open Door Forum (ODF) to allow Medicaid providers, Managed Care Organizations (MCOs), Medicaid partners and other Medicaid stakeholders an opportunity to learn more about and ask questions regarding CMS’s approach towards changing the Social Security Number-based Health Insurance Claim Numbers (HICN) to the new Medicare Beneficiary Identifier (MBI).

Instructions on how to attend this open forum: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/Downloads/02062018SODFAgenda.pdf

Providers readiness fact sheet: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TransitiontoNewMedicareNumbersandCards-909365.pdf

Feedback and questions on the New Medicare Card Project can be sent too: NewMedicareCardSSNRemoval@cms.hhs.gov

February 5, 2018: Attention ALL Providers: CHAMPS Direct Data Entry (DDE) issues have been resolved and the screens restored for providers. We apologize for any inconvenience.

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

February 5, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) has identified not all Managed Care (MA-MC, MA-HMP-MC etc.) benefit plan segments are displaying in CHAMPS eligibility screens correctly.Providers can use the 270/271 eligibility transaction to verify eligibility as a workaround until this issue is resolved.

Providers with further questions can contact Provider Support 1-800-292-2550 or email Providersupport@Michigan.gov

February 5, 2018: System Outage: Due to system release and maintenance the CHAMPS system will be down between 6:00 PM EST Saturday, February 10, 2018, through 9:00 AM EST Sunday, February 11, 2018. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

February 2, 2018: System Outage: Due to system maintenance the CHAMPS system will be down between 7:00 PM through 9:00 PM EST Saturday, February 3, 2018. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

February 2, 2018: Attention ALL Providers: Due to system issues, the CHAMPS Direct Data Entry (DDE) function is currently not accessible. MDHHS is working to resolve the issue and an additional notification will be posted when resolved. We apologize for any inconvenience.

 February 2, 2018: Attention Outpatient Hospital Providers: Providers may notice an increase of claim adjustment reason code A8 denials as the MDHHS CHAMPS system is processing current claims with the October 2017 quarterly APC/OPPS software and wrap around codes list. The implementation of the software for the January 2018 quarter is planned for March 23, 2018, and will resolve this issue. MDHHS asks that providers continue to bill for the services rendered using National Coding Guidelines for the date of service the charges were incurred on. Any claims affected by this software update will be processed in April and may be identified by the claim note: APC January 2018 quarterly updates.

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

February 1, 2018: Attention FQHC Dental Providers: Currently the CHAMPS system is not paying the APM rates associated with qualifying dental procedure codes. A system fix is currently scheduled for the end of March 2018. Once the fix is implemented previous incorrectly processed claims will be adjusted for proper claim adjudication. In addition, after the fix, these claims will pay the PPS rate plus the APM rate at the time of claim adjudication.

January 31, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) would like to remind Individual Providers when completing their enrollment within CHAMPS the ‘Associate MCO Plan’ step does not require the Managed Care Organization (MCO) or Medicaid Health Plan (MHP) Contract Agreement to be uploaded. This step is optional and is used to associate the provider with their participating or networked MCO or MHP.

Step by step CHAMPS enrollment instructions can be found on the Provider Enrollment website: http://www.michigan.gov/mdhhs/0,5885,7-339-71551_2945_42542_42543_42546-104293--,00.html

Providers with further questions can contact Provider Enrollment by phone at 1-800-292-2550 

January 25, 2018: Attention ALL Providers: Due to scheduled MILogin maintenance on Production MILogin for worker, third party, and citizen infrastructure, the CHAMPS system will not be accessible from 6:00 AM until 11:00 AM EST Sunday, January 28, 2018. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

January 25, 2018 & December 21, 2017: Attention ALL Providers: This serves as a reminder Managed Care Organization (MCO) providers furnishing services to Medicaid beneficiaries must enroll in CHAMPS. Medicaid rules prohibit payment to providers not appropriately screened and enrolled. Beginning March 1, 2018, MDHHS will prohibit MCOs from making payments to all typical rendering, referring, ordering and attending providers not enrolled in CHAMPS.

The timeline above applies to typical providers. MDHHS plans to start enforcing the enrollment of atypical providers in Fall 2018. MDHHS will release future updates as additional provider types become available in CHAMPS. 

Enrollment in CHAMPS neither requires nor mandates those providers who are part of a managed care network to accept Fee-for-Service Medicaid beneficiaries. Enrollment in CHAMPS is solely used for the purpose of screening providers participating in Medicaid.

Additional information can be found in MSA 17-48 policy bulletin, Medicaid Managed Care Provider Enrollment Requirement Memo

CHAMPS Provider Verification tool is available for providers to verify if a provider is enrolled/registered within CHAMPS. Select the My Inbox tab within CHAMPS and choose the Provider Verification option in the drop-box menu. Enter the NPI of the provider and select Verify.

January 24, 2018: Attention Clinic Providers (FQHC, RHC, and THC): It has been determined that the reduction factor for Medicaid secondary and tertiary claims is only working for Medicare primary claims. When billing with another primary payer, the primary payment is not being subtracted from the Medicaid PPS rate, resulting in overpayments. 

MDHHS is currently working on this issue and will update providers when a resolution has been determined. 

January 24, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) has identified an issue when an admission record is created for a beneficiary which does not have current eligibility or a beneficiary applying for coverage. Once the eligibility has been established and sent to CHAMPS, the benefit plans and PET codes are not updating.

Until this is resolved MDHHS will be performing a weekly correction file to:

  • Identify the impacted beneficiaries
  • Assign the appropriate benefit plans and PET codes based on the admission record
  • Update the admission record status from ‘Completed-waiting for MA’ to ‘Completed’. 

It is not necessary for providers to contact Provider Support to have these records corrected as MDHHS will be internally correcting these records.

Additional MCC resources can be found on the MCC portion of the Medicaid Provider Tips webpage.

Providers with further questions can contact Provider Support 1-800-292-2550 or email Providersupport@Michigan.gov

January 24, 2018: System Outage: Due to system release, the CHAMPS system will be down between 7:00 PM EST Friday, January 26, 2018, to 2:00 AM EST Saturday, January 27, 2018. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

January 19, 2018: Attention Outpatient Hospital and End Stage Renal Disease Providers: MDHHS is aware of a system issue with procedure code J0882-Darbepoetin Alfa, ESRD. For dates of service April 1, 2016, through December 31, 2016, the code was inadvertently terminated in the Medicaid system and removed from the MDHHS wrap-around code list causing claims to deny. The CHAMPS system and wrap-around code list are both projected to be updated in the next system release scheduled for March 23, 2018. An update will be posted once the system has been updated.

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

January 18, 2018: Attention Hospital Providers: This is an update to the notification posted on October 26, 2017. The October 2017 Quarterly APC & ASC software and APR DRG grouper 35 were both loaded into the system on December 29, 2017. MDDHS will identify affected claims and adjust or resurrect accordingly.

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

January 18, 2018: Attention Outpatient Hospital Providers: This is an update to the Biller “B” Aware posted on July 13, 2017. MDHHS recognizes that claims continue to be denied with CARC A8-ungroupable incorrectly. The affected claims have services that are assigned a payment status indicator G or K on Medicare’s Addendum B and the supporting payable procedure is on MDHHS wrap-around code list with an assigned MDHHS status indicator. The issue is projected to be fixed in the system update scheduled for March 23, 2018. A subsequent Biller "B" Aware will be posted once the issue is resolved with information for rebilling affected claims.

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

January 18, 2018: Attention ALL Providers: The latest batch of MDHHS Quarterly Newborn Recoveries is currently being processed. This batch includes fee for service claims for newborns that were retroactively enrolled in 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 18, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) would like to notify providers of the upcoming CMS New Medicare Card Open Forum on Tuesday, January 23, 2018, 2:00-3:00 PM EST.

CMS’s Office of Information Technology (OIT) will host a Special Open Door Forum (ODF) to allow Medicaid providers, Managed Care Organizations (MCOs), Medicaid partners and other Medicaid stakeholders an opportunity to learn more about and ask questions regarding CMS’s approach towards changing the Social Security Number-based Health Insurance Claim Numbers (HICN) to the new Medicare Beneficiary Identifier (MBI). 

Instructions on how to attend this open forum: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/Downloads/01232018SODFAgenda.pdf

Providers readiness fact sheet: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TransitiontoNewMedicareNumbersandCards-909365.pdf

Feedback and questions on the New Medicare Card Project can be sent to NewMedicareCardSSNRemoval@cms.hhs.gov

January 16, 2018: Attention ALL Providers: The CHAMPS system issues have been resolved and the Archived Documents function has been restored and is functioning properly. We apologize for any inconvenience.

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

January 10, 2018: Attention ALL Providers: Due to system issues, the CHAMPS Archived Documents function is still not accessible. MDHHS is continuing to work on resolving the issues. Notification will be posted when resolved. We apologize for any inconvenience.

January 9, 2018: Attention ALL Providers: MDHHS would like to remind providers when adding other insurance information in the MCC Admission screens to enter the greatest demographic information available (e.g. policy name, policy number, policyholder etc.). Provide all known information so that Third Party Liability (TPL) can validate the policy information reported for possible addition to the beneficiaries TPL file.  Providers should only report other insurance information not found on the CHAMPS TPL coverage file. Information regarding coverage already on file can be found using the ‘View TPL’ hyperlink in the MCC Admission screens.
Providers with further questions can contact Provider Support by email ProviderSupport@Michigan.gov.
 

January 8, 2018: System Outage: Due to system maintenance, the CHAMPS system will not be accessible from 6:00 PM EST Saturday, January 13, 2018, through 9:00 AM EST Sunday, January 14, 2018. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

January 4, 2018: Attention ALL Providers: Due to system issues the CHAMPS Archived Documents function is currently not accessible. MDHHS is working to resolve the issue and an additional notification will be posted when resolved. We apologize for any inconvenience.

January 4, 2018: Attention Hospice Providers: MSA policy bulletin MSA 17-46, issued December 1, 2017, requires that hospice providers print the admission form in CHAMPS and obtain the beneficiary (or authorized representative) signature and hospice provider personnel signature on the form.  For hospice providers unable to print the admission form generated by CHAMPS (due to admissions during home visits, after hours etc.), hospice providers may instead utilize an alternative form the “Hospice Election Statement” that meets the Medicare requirements outlined in MLN Matters Number SE1631, issued December 13, 2016. 

As of January 2, 2018, the hospice beneficiary’s or authorized representative’s signature and hospice provider personnel completing the admission must be present on the Hospice Election Statement form. It is the hospice provider’s responsibility to upload a copy of the signed Hospice Election Statement form to the Document Management Portal (DMP) in conjunction with the completion of the hospice admission or discharge in CHAMPS. The printed admission generated by CHAMPS and the signed Hospice Election Statement form must be retained in the beneficiary’s record. This clarification will also be issued in the April 2018 Michigan Medicaid Provider update bulletin.

When uploading the Hospice Election Statement form to DMP, follow the guidelines as listed below:

Document Type: Claim

Document Title: Forms

Date of Service From: Enter the hospice election date

Date of Service to TCN: Enter the hospice election date

Message: Hospice Election Statement

After the alternative form is uploaded, providers may verify receipt by searching the beneficiary ID number in DMP.

 

First-time users of Document Management Portal please review the DMP users guide.

 

January 2, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) has been notified that Patient Pay Amounts (PPA) are not displaying in the CHAMPS eligibility screen. MDHHS is working to resolve this issue and further notification will be posted when resolved.

Providers with further questions can contact Provider Support by email ProviderSupport@Michigan.gov

 

2017 Biller B Aware Archive

2009-2016 Biller B Aware Archive


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Modernizing Continuum of Care (MCC)

 

Resources

Virtual Training Presentations 

Virtual Training Q&A's

LOC to PET Crosswalk

January 25, 2018: Post Implementation

January 25, 2018

Frequently Asked Questions (FAQ)

January 11, 2018: Post Implementation

January 11, 2018

Policy Bulletins                   

MSA 17-33 

MSA 17-40 

MSA 17-46

December 7, 2017: Overview

December 7, 2017

November 16, 2017: Overview 

November 16, 2017

November 14, 2017: SNF and Hospice Specific  

 
September 18, 2017: Overview September 18, 2017

 

February 8, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) has identified an issue with Patient Pay Amount (PPA) not displaying within the CHAMPS member eligibility screen. Until this is resolved providers should report the known monthly PPA on their claim or if unknown contact the MDHHS county worker. It is not necessary for providers to contact Provider Support to have these records corrected. 

January 24, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) has identified an issue when an admission record is created for a beneficiary which does not have current eligibility or a beneficiary applying for coverage. Once the eligibility has been established and sent to CHAMPS, the benefit plans and PET codes are not updating.

Until this is resolved MDHHS will be performing a weekly correction file to:

  • Identify the impacted beneficiaries
  • Assign the appropriate benefit plans and PET codes based on the admission record
  • Update the admission record status from ‘Completed-waiting for MA’ to ‘Completed’. 

It is not necessary for providers to contact Provider Support to have these records corrected as MDHHS will be internally correcting these records. Providers with further questions can contact Provider Support 1-800-292-2550 or email Providersupport@Michigan.gov

January 4, 2018: Attention Hospice Providers: MSA policy bulletin MSA 17-46, issued December 1, 2017, requires that hospice providers print the admission form in CHAMPS and obtain the beneficiary (or authorized representative) signature and hospice provider personnel signature on the form.  For hospice providers unable to print the admission form generated by CHAMPS (due to admissions during home visits, after hours etc.), hospice providers may instead utilize an alternative form the “Hospice Election Statement” that meets the Medicare requirements outlined in MLN Matters Number SE1631, issued December 13, 2016. 

As of January 2, 2018, the hospice beneficiary’s or authorized representative’s signature and hospice provider personnel completing the admission must be present on the Hospice Election Statement form. It is the hospice provider’s responsibility to upload a copy of the signed Hospice Election Statement form to the Document Management Portal (DMP) in conjunction with the completion of the hospice admission or discharge in CHAMPS. The printed admission generated by CHAMPS and the signed Hospice Election Statement form must be retained in the beneficiary’s record. This clarification will also be issued in the April 2018 Michigan Medicaid Provider update bulletin.

When uploading the Hospice Election Statement form to DMP, follow the guidelines as listed below:

Document Type: Claim

Document Title: Forms

Date of Service From: Enter the hospice election date

Date of Service to TCN: Enter the hospice election date

Message: Hospice Election Statement

After the alternative form is uploaded, providers may verify receipt by searching the beneficiary ID number in DMP.

First-time users of Document Management Portal please review the DMP users guide.

 

January 2, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) has been notified that Patient Pay Amounts (PPA) are not displaying in the CHAMPS eligibility screen. MDHHS is working to resolve this issue and further notification will be posted when resolved.

Providers with further questions can contact Provider Support by email ProviderSupport@Michigan.gov

December 18, 2017: Attention ALL Providers: As part of MCC, January 2, 2018, provider’s that need to add or view admission records (required for certain provider types as outlined within MSA 17-46) will need to select the applicable profile when logging into CHAMPS.

January 2, 2018, MDHHS will manually add one of the below-listed specialty-driven admission profiles to all CHAMPS Full Access Profile users. The CHAMPS profile options available will be determined by a providers NPI enrollment information in CHAMPS. Admission profile options are: Hospital Admission, NF Admission, Hospice Admission, MI Choice Enrollment, PACE Enrollment or SPF Admin.

Providers who need to have an admission profile added after January 2, 2018, will need to work with their domain administrator to obtain the appropriate access.

For a list of MCC training dates and to register, please visit our Medicaid Provider Training webpage.

Providers with further questions can contact Provider Support 1-800-292-2550 or email Providersupport@Michigan.gov

November 20, 2017: Attention SNF and Hospice Providers: As part of the Modernizing Continuum of Care (MCC) project CHAMPS will become the source or record for beneficiary admissions and enrollments. After MCC implementation, January 2, 2018, the current paper MSA 2565-C will be repurposed and the DCH-1074 paper process eliminated.  The MDHHS county caseworker will no longer update the admission or enrollment information via the Bridges eligibility system. Providers should submit their MSA 2565-C and DCH-1074 paper forms to the MDHHS county caseworker by December 15, 2017.

Beginning in January 2018 Providers will be required to enter the admission, enrollment and discharge notice through CHAMPS via the admission/enrollment and discharge screens.

For a list of MCC training dates and to register, please visit our Medicaid Provider Training webpage.

Additional MCC resources can be found on the MCC portion of the Medicaid Provider Tips webpage.

Providers with further questions can contact Provider Support by email ProviderSupport@Michigan.gov. 

 


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All Providers

December 27, 2017: Updated screens as of January 2, 2018: CHAMPS how to adjust a claim with other insurance

December 19, 2017: Medicaid Managed Care Provider Enrollment Requirement Memo 

December 13, 2017: CHAMPS Cloud Prior Authorization screen changes

December 11, 2017: Compound Drug billing tip

November 17, 2017: Suspended Claims Tip 

November 9, 2017: Modernizing Continuum of Care (MCC) Frequently Asked Questions (FAQ) 

October 4, 2017: Modernizing Continuum of Care (MCC) Virtual Training

September 26, 2017: Other insurance reporting requirements

September 18, 2017: CHAMPS claim status instructions

August 15, 2017: LOC to PET Crosswalk Table

June 13, 2017: How to verify associated and authorized billing agents within a provider's enrollment information

June 5, 2017: Billing the Medicaid beneficiary Tip *updated as of October 3, 2017

May 16, 2017: Medicare Buy-in Requests *updated as of October 3, 2017

May 15, 2017: Pharmacist Medication Therapy Management (MTM) Virtual Training

March 7, 2017: Determining Eligibility Virtual Training 

February 22, 2017Incarceration Benefit Plan Billing Tips

January 26, 2017: New Timely Filing (CARC 29) Policy effective January 1, 2017 *updated as of October 3, 2017

January 26, 2017: CHAMPS Claim Status

August 01, 2016:  Document Management Portal (DMP) for Children’s Special Health Care Services

July 19, 2016: Documental Management Portal (DMP) Messaging Function for Predictive Modeling

April 21, 2016: Hearing Providers: Audiologists individual NPI must be associated to a Hearing Aid Dealer or Hearing Center billing NPI; for claim adjudication.

March 02, 2016: Billing Newborn Services when mother is enrolled in a Medicaid Health Plan (MHP)
If the mother is enrolled in a Medicaid Health Plan (MHP) at the time of delivery, the newborn's services are also the responsibility of the MHP unless the child is placed in foster care. Providers are encouraged to review MSA L-Letter 15-66 for current policy information. Providers are advised to validate the mother's enrollment in an MHP when rendering services for newborns to ensure services are billed appropriately to the correct payer. All newborn charges must be billed to the MHP using the newborn’s ID.

 


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Ambulance

April 20, 2016: Billing two Separate Runs on the same DOS

 


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Clinics

December 20, 2017: Tribal Health Center (THC) Presentation

December 14, 2017: Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC) Presentation

December 13, 2017: Local Public Health Department (LPHD) Presentation

August 10, 2017: Clinic Revenue Codes 

May 25, 2017: Clinic Institutional FAQ 

 


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Dental

 

April 26, 2016: Verifying Dental Eligibility: For beneficiaries that are Medicare eligible and are not Medicare enrolled, the other insurance field will appear with Medicare and all 11111111 or 22222222. Even though Medicare does not pay for dental services, beneficiaries must obtain Medicare before the system can process and by-pass dental claims. The only exception is if the beneficiary is an alien and has not been in this country for 5 years. The date and port of entry must be reflected in the claim remarks. 

 


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Home Health

August 10, 2017: Home Health aide services are covered only when ordered by the attending physician and performed in conjunction with direct ongoing skilled nursing care and/or PT.
When submitting claims and reporting aide services along with skilled nursing care or physical therapy, it’s recommended to report the services in the following sequential order to allow for proper processing. The nursing and/or PT HCPCS code on the first claim line, followed by the Aide HCPCS codes. 
CHAMPS logic looks for a PAID nursing or physical therapy HCPCS service line during the same calendar month. Therefore when billing both services on the same claim, aide services could be denied if the service line is billed out of order. 

 


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Hospice

January 30, 2018:  MCC Post Implementation Virtual Training on (January 25, 2018)

January 11, 2018:  MCC Post Implementation Virtual Training

January 4, 2018: MSA policy bulletin MSA 17-46, issued December 1, 2017, requires that hospice providers print the admission form in CHAMPS and obtain the beneficiary (or authorized representative) signature and hospice provider personnel signature on the form.  For hospice providers unable to print the admission form generated by CHAMPS (due to admissions during home visits, after hours etc.), hospice providers may instead utilize an alternative form the “Hospice Election Statement” that meets the Medicare requirements outlined in MLN Matters Number SE1631, issued December 13, 2016. 

As of January 2, 2018, the hospice beneficiary’s or authorized representative’s signature and hospice provider personnel completing the admission must be present on the Hospice Election Statement form. It is the hospice provider’s responsibility to upload a copy of the signed Hospice Election Statement form to the Document Management Portal (DMP) in conjunction with the completion of the hospice admission or discharge in CHAMPS. The printed admission generated by CHAMPS and the signed Hospice Election Statement form must be retained in the beneficiary’s record. This clarification will also be issued in the April 2018 Michigan Medicaid Provider update bulletin.

When uploading the Hospice Election Statement form to DMP, follow the guidelines as listed below:

Document Type: Claim

Document Title: Forms

Date of Service From: Enter the hospice election date

Date of Service to TCN: Enter the hospice election date

Message: Hospice Election Statement

After the alternative form is uploaded, providers may verify receipt by searching the beneficiary ID number in DMP.

 

First-time users of Document Management Portal please review the DMP users guide.

Updated January 3, 2018: MCC Frequently Asked Questions (FAQ)  *originally posted November 9, 2017

November 14, 2017: Modernizing Continuum of Care (MCC) SNF and Hospice Training

October 4, 2017: Modernizing Continuum of Care (MCC) Virtual Training

August 15, 2017: LOC to PET Crosswalk Table

 


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Hospital

December 7, 2017: MCC Overview Virtual Training 

September 27, 2017: Common Hospital Claim Denials

 

August 10, 2017: Attending Provider Tip *updated as of November 16, 2017

 

July 17, 2017: Inpatient Hospital A8 Claim denial Tip
 

June 5, 2017: Billing the Medicaid beneficiary Tip *updated as of October 3, 2017

 

May 16, 2017: Spend-Down Billing Tip
 

May 16, 2017: Medicare Buy-in Requests *updated as of October 3, 2017

 

April 10, 2017: Compound Drug Billing Tip
 

March 29, 2017: Reporting HSA/FSA/HRA Payments to MDHHS Tip
 

February 22, 2017Incarceration Benefit Plan Billing Tips
 

February 17, 2017Self-Administered Drugs Billing Tip
 

February 16, 2017: Outpatient Hospital Drug Carveout information
 

February 02, 2017: Hospital Fee for Service (FFS) Claim Appeal first step instructions
 

January 26, 2017: New Timely Filing (CARC 29) Policy effective January 1, 2017 *updated as of October 3, 2017

 

January 12, 2017:  Predictive Modeling/Document Management Portal (DMP) Billing Tips
 

January 11, 2017:  Inpatient Hospital Psychiatric Admissions Billing Tip
 

November 01, 2016: Inpatient ICD-10 Surgical Codes with Documentation Requirements *updated as of February 2, 2018

 

November 01, 2016: ICD-10 Surgical Procedure Codes Requiring Prior Authorization *updated as of February 2, 2018

 

September 27, 2016: PACER Requirements Billing Tip
 

August 11, 2016: Hospital Claim Newborn Coverage Tips
 

May 04, 2016: A8 Outpatient Hospital Claim Denials
 

April 20, 2016: Re-Billing Hospital Claims
 

April 20, 2016: Three Day Window Billing Tip
 

April 20, 2016: Pricing Outpatient Hospital Claims
 

March 23, 2016: IPH Pricing Billing Tip  *updated as of July 19, 2017
 

March 22, 2016: Diagnosis Inconsistent with Procedure Billing Tip
 

February 18, 2016: Credit Balance Billing Tip
 

February 18, 2016: Timely Filing Billing Tip
 

June 04, 2015How to use the CHAMPS Claim Limit List
 

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

April 08, 2013: How to Find Professional REV Codes *updated as of March 31, 2017
 

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). 

 


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Nursing Facility

January 30, 2018:  MCC Post Implementation Virtual Training (January 25, 2018) 

January 11, 2018:  MCC Post Implementation Virtual Training

Updated January 3, 2018: MCC Frequently Asked Questions (FAQ)  *originally posted November 9, 2017

November 14, 2017: Modernizing Continuum of Care (MCC) SNF and Hospice Training

October 4, 2017: Modernizing Continuum of Care (MCC) Virtual Training

August 15, 2017: LOC to PET Crosswalk Table

March 22, 2017: Nursing Facility Virtual Training

January 26, 2017: How to filter Level of Care Determination (LOCD) within CHAMPS

January 26, 2017: Locating Provider ID within CHAMPS

January 26, 2017Instructions on Inactive Level of Care Determination (LOCD) Completed waiting for LOC/MA


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Pharmacy/DME

November 17,2017: DME providers receiving a denial for items included in the Nursing Facility (NF) Per Diem (CARC 97 RARC M97): Providers billing for DME or Medical Supplies that are included in the Nursing Facility per diem, and the date of service is the same date that the Level of Care (LOC) 02 ended, provider should report the date of discharge from the nursing facility on the claim.

May 15, 2017: Pharmacist Medication Therapy Management (MTM) Virtual Training 

April 26, 2016: DME Provider Verification Tool

April 20, 2016: Blood Glucose Monitoring Equipment and Supplies

 


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Physician/Professional

October 3, 2017: Physician Emergency Room Charges Tip

 

September 28, 2017: Prior Authorization Tip

 

September 5, 2017: Billing Tip-Common Denials

 


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School-Based Services (SBS) 

December 6, 2017:  LEA and ISD: Facility Settlement Presentation

Other Resources:


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