MI Department of Community Health

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MI Department of Community Health

• Medical Services Administration
• Tamara J. Warren- Provider Liaison

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Medicaid Updates

• November 1, 2004 HIPAA 837v4010A1
• New optional procedures for paper claims
  processing
• Online Medicaid Manuals
• Medicaid Billing Help Sessions
• New Biller Training

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New options for paper claims

• Nordic Technologies and Netwerkes will begin
  processing paper claims for high volume paper
  providers.
• Any provider who submits a substantial amount of
  paper claims can participate.
• Both Netwerkes and Nordic will convert paper
  claims into HIPAA electronic formats.
• This is an optional process for providers which
  is free of charge.

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Paper Claims processing

• Currently Medicaid does not offer a claims
  statusing on either paper or electronic claims.
• Paper claims can take up to 4 months to process.
• Providers are encouraged to bill electronically
  whenever possible.
• Electronic claims are processed within 7-14
  business days.

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Medicaid Resources

• MDCH website www.michigan.gov/mdch
• Provider Inquiry Line
• 1-800-292-2550
• Provider Support e-mail address
• Providersupport_at_Michigan.gov

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Common Billing Errors on the HCFA 1500 Claim
Format
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Modifier Usage

• The Billing and Reimbursement Chapter, section 7
  provides information on Modifier usage for claims
  submitted to Medicaid
• Special services such as Vision and DME, also
  reference modifier usage on the MA database
  available at the MDCH website.

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Sterilization Consent Forms

• Consent forms may be downloaded at the MDCH
  website
• Forms may be faxed to 517-241-7856 or the actual
  form may be mailed in with the claim
• If the consent form has been faxed enter consent
  on file in Item 19 (remarks)
• NOTE Claims will pend with the 104 edit for
  review of the filed consent form.

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Coordination of Benefits Codes (Paper Claims)

• The appropriate COB code should be listed for
  each service line
• Billing and Reimbursement Chapter, references the
  covered COB codes for billing paper claims.

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Medicare Part B (WPS) crossover claims

• Medicaid began accepting Medicare crossover
  claims 8-1-2004.
• Providers must enter the Medicaid Provider ID
  number on the claim to Medicare.
• Providers must report this information on their
  electronic claim submission to Medicare for the
  crossover process to take place.

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Crossover Claims- Electronic Format

• The Medicaid provider ID must be reported in
  addition to the Medicare provider ID by repeating
  Loop ID 2010AA REF01 and REF02 on a crossover
  claim
• Loop ID 2010AA REF01 Enter 1D for Medicaid.
• Loop ID 2010AA REF02 Enter the 9-digit Medicaid
  provider ID (2-digit provider type followed by
  the 7-digit number)

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Medicaid Remittance Advice Information
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Request for the 835

• Providers must complete the form at the MDCH
  website (Electronic Billing) entitled Electronic
  Remittance Advice Request form.
• Providers are encouraged to sign up early to
  become familiar with the 835 format, before
  proprietary files become unavailable.
• Requests take approximately one week to process.

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Records Retrieval

• Providers must submit requests for Remittance
  Advice information to Fax [phone].
• Requests must be submitted on company letterhead
  and include the following information
• Paycycle/date
• Provider Type and Medicaid ID Number
• Provider Phone number and Fax Number
• Name of the person requesting the Fax
• NOTE If the information requested requires
  numerous pages it will be mailed to the address
  on the letterhead. Minimal Fees may apply.

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Medicaid Provider FAQ

• Medicaid Billing
• Frequently Asked Questions

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Provider Questions

• How do I report other insurance information that
  has been terminated?
• You may also report the terminated insurance
  information on the HCFA 1500 by using COB code 8
  (item 24 J) and entering in remarks Item 19 the
  policy number and date insurance was canceled.
• TPL_Health_at_Michigan.gov
• Fax [phone]

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Medicare Buy In Unit

• Contact Information
• Phone [phone]
• Fax [phone]

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Provider Input Session
Medicaid welcomes suggestions for improvement
from the provider community.