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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
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]
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)
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.
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