NEW Medicaid Claims and MDHHS Billing Requirements for the New Year

January 13, 2020

Medicaid claims that do not meet the Michigan Department of Health and Human Services (MDHHS) billing requirements are being rejected as of Jan. 1, 2020.

These billing requirements are part of the Community Health Automated Medicaid Processing System (CHAMPS) enrollment requirement. You can view a list of Medicaid billing requirements in the MDHHS provider bulletin in section IV - Billing Submission. Billing requirements can also be reviewed in the State’s Provider Manual.

How did we prepare you for this change?

For the last year, we’ve sent warning edits via electronic remit advice and standard paper remit informing you of Medicaid billing changes occurring on Jan. 1, 2020. The warning edits are:

  • 1775 – Rendering NPI is an Entity or Group
  • 5167 – Claims type requires a referring/ordering NPI
  • 5169 – Provider type not allowed for referring/ordering/attending NPI

MDHHS has also notified Medicaid providers of these requirements via provider bulletin.

 

We’re now implementing the Medicaid billing requirements

As of Jan. 1, 2020, we’re rejecting claims that do not meet Medicaid billing requirements.

 

What do you need to do?

Correct any claims that have been rejected with these edits and resubmit claims for payment.