MI Department of Community Health

MI Department of Community Health

Medical Services AdministrationTamara J. Warren- Provider Liaison

Medicaid Updates

November 1, 2004 HIPAA 837v4010A1

New optional procedures for paper claims processing

Online Medicaid Manuals Medicaid Billing Help Sessions New Biller Training

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.

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.

Medicaid Resources

MDCH website www.michigan.gov/mdch

Provider Inquiry Line1-800-292-2550

Provider Support e-mail [email protected]

Common Billing Errors on the HCFA 1500 Claim Format

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.

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.

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.

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.

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)

Medicaid Remittance Advice Information

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.

Records Retrieval Providers must submit requests for Remittance

Advice information to Fax 517-335-5562. Requests must be submitted on company

letterhead and include the following information:

Paycycle/date

Provider Type and Medicaid ID NumberProvider Phone number and Fax NumberName 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.

Medicaid Provider FAQ

Medicaid Billing Frequently Asked Questions

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.

[email protected] Fax 517-335-8868

Medicare Buy In Unit Contact Information

Phone 517-335-5488

Fax 517-335-0478

Provider Input Session

Medicaid welcomes suggestions for improvement from the

provider community.