Up and Coming Initiatives

New CMS Medicare ID Cards Project

 

 

             


Provider Tips

 

Provider Tips Archive



July 6, 2018: System Outage: Due to system maintenance, the CHAMPS system will be down between 6:00 PM EST Saturday, July 14th through 9:00 AM EST Sunday, July 15th, 2018. This outage will affect the CHAMPS system access for all functionality.

July 3, 2018: Attention Outpatient Hospital Providers: This is an update to the notification posted April 13, 2018. MDHHS has resolved the system issue affecting claims that have a payment status indicator K or G on Medicare’s Addendum B and the supporting payable procedure is on MDHHS wrap around list with an assigned MDHHS status indicator. This issue was fully resolved for all providers and all dates of service with the April 2018 OPPS/ASC quarterly updates implemented on June 22, 2018. Providers with affected claims are advised to rebill claims for correct adjudication. For claims that are outside of timely filing providers will need to append the claim note “OCE 99”

Providers with additional questions can contact Provider Support at 1-800-292-2550 or Providersupport@michigan.gov

July 3, 2018: Attention Outpatient Hospital Providers: The April 2018 quarterly APC/OPPS software was successfully updated as part of the CHAMPS system  update on June 22, 2018. MDHHS will attempt to reprocess all claims that were processed under the previous quarters software. If providers find claims that were missed by MDHHS during the recycling process we suggest that providers rebill or adjust the claims with claim note “ Previous TCN XXXXXXXXXXXXXXXXXX rebilling April 2018 quarterly updates”

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

July 2, 2018:  Attention All Providers: The Michigan Department of Health and Human Services (MDHHS) has recently updated the CHAMPS web-page www.Michigan.gov/medicaidproviders >> CHAMPS. The page has a new look and feel while preserving the previous materials. 

If you have any questions, please email ProviderOutreach@Michigan.gov

June 28, 2018: Attention Rural Health Clinic Providers: Beginning on July 1, 2018 MDHHS will begin voiding claims where the T1015 visit code is being billed without a qualifying visit code. MDHHS will continue to void claims on a quarterly basis until a system fix can be put in place.

June 22, 2018: MILogin Outage: Due to a scheduled system maintenance, the MILogin Production system users may experience intermittent service interruptions on Sunday, June 24th, 2018, from 6:00 AM EST to 12:00 PM EST.  This will impact all MILogin Production Worker, Third party, and Citizen Systems functionality.  We apologize for any inconvenience this may cause.

June 20, 2018: Attention All Providers: The Center for Medicare & Medicaid Services (CMS) has issued additional guidance regarding the Bipartisan Budget Act of 2018 which was signed into law February 9, 2018. Previously, the law required that state Medicaid Agencies make payments for prenatal services, including screening and diagnosis, within 30 days without regard to third party liability, and if a third party is found to be liable, seek reimbursement after payment is made. For dates of service on or after February 9, 2018, Michigan Medicaid will use standard coordination of benefits cost avoidance when processing prenatal services claims.

Providers must bill prenatal service to the primary payer per MSA policy outlined in the provider manual, Coordination of benefits Chapter, Section 1.3 Verification of Other Insurance. Once the claim has been processed by the primary payer, providers can bill their claim to Medicaid reporting the primary payer information.

In the future MDHHS will void prenatal claims with dates of service on or after February 9, 2018 that paid and reported no primary insurance.

CMS bulletin: https://www.medicaid.gov/federal-policy-guidance/downloads/cib060118.pdf

June 20, 2018: System Outage: Due to system release, the CHAMPS system will be down between 7:00 PM EST Friday, June 22nd through 2:00 AM EST Saturday, June 23rd, 2018. This outage will affect the system access for all functionality. We apologize for any inconvenience.

June 18, 2018: Attention SNF, Hospice, Hospital Providers: As a reminder when emailing Provider Support regarding an Admission, Discharge, PET code missing, or LOCD inquiry please ensure the email contains all the following information:

  • NPI
  • Beneficiary ID
  • Transaction ID
  • Admission Date
  • Discharge Date
  • A brief description of what needs to be corrected or the issue

Skilled Nursing Facility (SNF) providers:

  • If the beneficiary received Hospice services while in the Nursing Facility, include date range(s)
  • LOCD Created Date

This will allow Provider Support to adequately review the inquiry and provide a quicker response. Email ProviderSupport@Michigan.gov with questions or concerns.

June 13, 2018: System Outage: Due to MILogin system maintenance, the CHAMPS system will be down between 9:00 PM EST until 10:00 PM EST on Thursday, June 14th, 2018. This outage will affect the system access for all functionality. We apologize for any inconvenience.

June 13, 2018: Attention All Providers: The Michigan Department of Health and Human Services (MDHHS) would like to remind providers of their obligation to adjust claims when a primary or other insurance payer recovers a payment. The claim should be adjusted to update the other insurance dollar amounts or remove the other insurance information completely if no longer applicable. A claim note indicating the reason for the recovery or negative payment amount from the other insurance should be submitted for the claim to be considered for payment. 

Providers cannot bill beneficiaries for services except for the situations outlined in the MSA Provider Manual, General Information for Providers Chapter, Section 11-Billing Beneficiaries. 

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

June 11, 2018: Attention All Providers: The Michigan Department of Health and Human Services (MDHHS) has identified claims that adjudicated on or after 2015 that reported Medicare primary in the other payer’s information and processed and paid incorrectly.  

The identified claims reported:

  • Medicare primary with CARC 2, Coinsurance Amount, and no Medicare primary payment

OR

  • Medicare primary with CARC 1, Deductible Amount, over the yearly Medicare Deductible amount for the date of service:
    • 2015=$147.00
    • 2016=$166.00
    • 2017 and 2018= $183.00

Providers should review their paid claim(s) and adjust the claim(s) to make the necessary corrections to the CARC or dollar amount. Providers should include a claim note indicating why the claim(s) are being adjusted.

MDHHS will begin voiding the identified claims on pay cycle 29, July 19, 2018, until complete. The voided claims can be identified with claim note “OICU Recovery due to incorrect OI reporting of Medicare”. 

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

May 29, 2018: System Outage: Due to system maintenance, the CHAMPS system will be down between 8:00 PM EST Friday, June 8th through 8:00 PM EST Sunday, June 10th, 2018. This outage will affect the CHAMPS system access for all functionality. Due to this extended outage, the 270/271 batch, real-time and online transactions will be unavailable until Monday, June 11, 2018. We apologize for any inconvenience.

May 22, 2018: Attention ALL Providers: As outlined in L-Letter 17-61 the Michigan Department of Health and Human Services (MDHHS) will be making changes to the Level of Care Determination (LOCD) tool. The system changes will take place in CHAMPS as part of the June 22, 2018 update. 

MDHHS will offer virtual training dates to discuss in further detail these LOCD system changes:

  • LOCD screen will have a new search by NPI feature
  • Completed LOCD’s will have an end date of 365 days from the conducted-on date
  • Conducted on date will be a visible field in the LOCD tool screen
  • Ability to view the LOCD from the admission screen

To register for a virtual training date please visit our Medicaid Provider Training webpage.

May 15, 2018: Attention ALL Submitters: The DTMB File Transfer Service (FTS) portal is incorrectly allowing submitters to log in with a lower case DEG ID or username, DCHXXXX. Submitters are reminded that the DEG ID username should be entered in all uppercase when logging into the FTS as outlined in the electronic submission manual, section 4.1.3 Logging onto the MDHHS Internet Connection.

Electronic files submitted using a lower case DEG ID will fail to load into CHAMPS and submitters will need to resubmit the file using the correct uppercase DEG ID.

May 14, 2018: Attention ALL Providers: The Centers for Medicare & Medicaid Services is in the process of removing Social Security Numbers (SSN) from Medicare cards to prevent fraud, fight identity theft, and keep taxpayer’s dollars safe. The current Health Insurance Claim Number (HICN) will be replaced with a new unique Medicare Beneficiary Identifier (MBI). Providers can use the MBI as soon as it’s received.

April 2018 – April 2019: Removal of SSN and distribution of New Medicare Cards with MBI.

April 2018 – December 2019: Confirm system acceptance and transmission of the new MBI.

January 1, 2020: Providers are required to use the new MBI.

Three Ways Providers Can Locate a New MBI:

  • Ask your Medicare patients: Medicare is mailing the new Medicare cards in phases by geographic location to people with Medicare. Ask your Medicare patients for their new Medicare card when they come for care. If they’ve received a new card, but do not have it with them at the time of service, remind them they can use MyMedicare.gov to get their new Medicare number.
  • Use the Medicare Administrative Contractors’ (MAC) secure MBI look-up tool: Learn about and sign up for the Portal to use the tool when it’s available in June 2018. Providers can look up MBIs for their Medicare patients who don’t have their new cards when they come for care.
  • Check the remittance advice: Starting in October 2018 through the end of the transition period, Medicare will return the MBI on every remittance advice when providers submit claims with valid and active HICNs.

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

May 7, 2018: System Outage: Due to system maintenance, the CHAMPS system will be down between 6:00 PM EST Saturday, May 12th through 9:00 AM EST Sunday, May 13th, 2018. This outage will affect the CHAMPS system access for all functionality. We apologize for any inconvenience.

May 3, 2018: UPDATE to Non-Clinic Dental Providers BBA posted April 12, 2018: The dental issue resulting in claims being underpaid has been corrected. MDHHS has adjusted the claims and providers should see these claims appear on their remittance advice within the next 2 pay cycles. The adjusted claims can be identified with claim note “Dental Paying $0 Adjustments”.  

May 2, 2018: Outpatient Hospitals and End-Stage Renal Disease (ESRD) Providers: Effective for dates of service on or after January 1, 2017, procedure code G0491, dialysis procedure at a Medicare-certified ESRD facility for acute kidney injury without ESRD, has been added to MDHHS wrap-around list as a covered service. MDHHS will follow CMS guidelines for reporting and billing of beneficiaries with the CMS approved Acute Kidney Injury diagnosis codes. MDHHS will reprocess affected claims retroactively up to January 1, 2017, scheduled for June 22, 2018, along with the April 2018 APC/OPPS quarterly updates. Providers with questions can contact Provider Support at 1-800-292-2550 or Providersupport@Michigan.gov

April 25, 2018: Institutional Providers: MDHHS is aware of the issue on the FD 622 Report for pay cycle 14, pay date 4/05/2018; it is not reflecting the specific “Funding Source”. MDHHS is currently working to resolve the issue. Once the issue is resolved, the corrected FD 622 Report will be reposted. A subsequent notification will be sent once the issue is resolved.

 

 

2018 Biller B Aware Archive 

2009-2017 Biller B Aware Archive


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Modernizing Continuum of Care (MCC)

 

Resources

Virtual Training Presentations 

Virtual Training Q&A's

  March 28, 2018: MCC Updates March 28, 2018 & February 28, 2018
Steps for Entering an Admission and Discharge February 28, 2018: MCC Updates

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

 

June 18, 2018: Attention SNF, Hospice, Hospital Providers: As a reminder when emailing Provider Support regarding an Admission, Discharge, PET code missing, or LOCD inquiry please ensure the email contains all the following information:

  • NPI
  • Beneficiary ID
  • Transaction ID
  • Admission Date
  • Discharge Date
  • A brief description of what needs to be corrected or the issue

Skilled Nursing Facility (SNF) providers:

  • If the beneficiary received Hospice services while in the Nursing Facility, include date range(s)
  • LOCD Created Date

This will allow Provider Support to adequately review the inquiry and provide a quicker response. Email ProviderSupport@Michigan.gov with questions or concerns.

March 21, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) is aware of multiple issues in regards to PET code and Benefit Plan segments missing, updating and not assigning in real time.

Until these are resolved MDHHS will be performing correction files to:

  • Identify the impacted beneficiaries
  • Assign the appropriate benefit plans and PET codes based on the admission record
  • Add missing PET codes or benefit plan segments

Providers are encouraged to continue to view CHAMPS frequently to verify if the PET and Benefit Plans have been updated. We will continue to provide updates as they become available.

 


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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 *updated as of March 15, 2018

January 26, 2017: New Timely Filing (CARC 29) Policy effective January 1, 2017 *updated as of March 20, 2018

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 the 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 - PDF, Recording, Q&A 

December 14, 2017: Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC) Presentation - PDF, Recording, Q&A

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

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

June 18, 2018: Attention SNF, Hospice, Hospital Providers: As a reminder when emailing Provider Support regarding an Admission, Discharge, PET code missing, or LOCD inquiry please ensure the email contains all the following information:

  • NPI
  • Beneficiary ID
  • Transaction ID
  • Admission Date
  • Discharge Date
  • A brief description of what needs to be corrected or the issue

This will allow Provider Support to adequately review the inquiry and provide a quicker response. Email ProviderSupport@Michigan.gov with questions or concerns.

January 30, 2018:  MCC Post Implementation Virtual Training on (January 25, 2018) - PDF, Q&A

January 11, 2018:  MCC Post Implementation Virtual Training - PDF, Q&A

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 - PDF

October 4, 2017: Modernizing Continuum of Care (MCC) Virtual Training - RecordingQ&A

August 15, 2017: LOC to PET Crosswalk Table

 


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Hospital

December 7, 2017: MCC Overview Virtual Training - PDF, Q&A 

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 *updated as of March 15, 2018

 

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 March 20, 2018

 

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 March 15, 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 *updated as of March 15, 2018

 

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

June 22, 2018: LOCD CHAMPS System Changes- PDF

June 18, 2018: As a reminder when emailing Provider Support regarding an Admission, Discharge, PET code missing, or LOCD inquiry please ensure the email contains all the following information:

  • NPI
  • Beneficiary ID
  • Transaction ID
  • Admission Date
  • Discharge Date
  • A brief description of what needs to be corrected or the issue

Skilled Nursing Facility (SNF) providers:

  • If the beneficiary received Hospice services while in the Nursing Facility, include date range(s)
  • LOCD Created Date

This will allow Provider Support to adequately review the inquiry and provide a quicker response. Email ProviderSupport@Michigan.gov with questions or concerns.

January 30, 2018:  MCC Post Implementation Virtual Training (January 25, 2018) - PDF, Q&A

January 11, 2018:  MCC Post Implementation Virtual Training - PDF, Q&A

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 - Recording, Q&A

August 15, 2017: LOC to PET Crosswalk Table

March 22, 2017: Nursing Facility Virtual Training


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Pharmacy/DME

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

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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