BILLER "B"AWARE

November 20, 2009 - Medicare crossover claims are current in CHAMPS and are being processed for the month of November, 2009.  These claims will be listed on remittance advices.  The remittance advice(s) will reflect the paid and denied claims.  If you believe there are still missing claims, please contact providersupport@michigan.gov

November 20, 2009 - Between the hours of 6am and 6pm on Sunday, November 22, 2009, the CHAMPS system is scheduled for routine maintenance. The system will be unavailable until the maintenance operations have been completed.

November 6, 2009 - With CHAMPS implementation the payment to providers at tax ID level is including all Capitation payments with the Fee for Service (FFS) payments. All capitation payments can be viewed from the 820's that are produced and transmitted. The FFS payments can be viewed from the Remittance Advice found in Archived Documents in CHAMPS. If you have questions regarding your 820 information, please contact your CMH or MCO Contract Manager.

November 5, 2009 - The CHAMPS generated paper remittance advices (RA) can be found in the "Archived Documents" link located on the Provider Portal page or "My Inbox" subsystem. Only those users with the profile of CHAMPS Full Access or CHAMPS Limited Access will have the ability to view this information.  Paper RAs will be stored in CHAMPS for approximately three months. These documents are available to print or save for your records. In addition, MDCH was aware of missing RAs from remittance advice date 10/07/2009, this issue has been resolved. If providers feel they are missing a RA within this link, please contact provider support at providersupport@michigan.govor 800-292-2550.

November 4, 2009 -   Prior Authorization Numbers in CHAMPS: Providers have been experiencing a range of issues related to the use of prior authorization numbers on their claims. There were some changes to the format of the number. Pre-existing PA numbers remained their original 9-digits (i.g. 999999999). Pre-existing PACER numbers will appear in the PA system with the letter M added to the beginning, making them 10-digits (i.g. M999999999). The M was necessary to maintain the uniqueness of the PACER numbers as they were combined into one database with authorizations from other business areas. Providers should not include the M when billing though the ‘M' is necessary when querying the CHAMPS PA system. New Prior Authorizations and PACERs created in CHAMPS are now 10-digits, all numeric (i.g. 1111111111). These new PAs should be reported as 10-digits on claims.

If a provider has received a letter from PA in the past with a PA number on it but the number cannot be found in CHAMPS, please fax the original PA letter to the Prior Authorization Unit explaining that the PA cannot be found in CHAMPS so that they can re-enter the PA data into CHAMPS.

MDCH is also investigating issues related to billing multiple lines of prior authorized services. Currently providers are reporting that only the first line is being paid and subsequent claim lines are being denied. Providers will continue to be informed of resolutions to these issues as soon as they have been finalized.

November 4, 2009 - Attention Institutional Billers- Updated 11/14/09: Evaluation and management CPT codes reported on institutional outpatient claims with modifier 25 or 59 have been denied in error.  After the issue has been resolved, MDCH will recycle the affected claims for proper adjudication.

November 4, 2009 - Executive Order 2009-22 - Elimination of Certain Medicaid Benefits for Adults 21 years & older: In July, dental benefits were restricted for adults 21 years and up to certain urgent/emergent services only. Vision, hearing, chiropractic, and podiatry services were also eliminated for adults 21 years and over (See MSA Bulletin 09-28 for details). Currently, there is an issue with the editing of these claims for age and date of service. MDCH will reprocess the affected claims upon correction of system logic. The Claim Adjustment Reason Code (CARC - 17) and Remittance Advice Remark Code (CARC - N379) reported for these denials was also incorrect. These issues are being addressed separately. A complete review of CARC and RARC reported on remittance advice is underway and the updates to the system are expected to be finalized in December.

November 4, 2009 -   Attention CMH Providers: Currently, claims for psychotropic injectables are being denied in CHAMPS because the combination of billing and rendering NPI on the claim is not recognized as appropriate for the specific procedure codes being billed. This is an internal coding issue that MDCH is addressing. MDCH will add a new specialty to all fee-for-service CMH enrollments in CHAMPS so that CMHs currently enrolled as Children's Waiver and/or SED Waiver agencies can bill for psychotropic drugs also. MDCH must also add the specialty to claims adjudication and financial management logic. All of the necessary changes are expected to be complete in early to mid-December. After completion, MDCH will reprocess all of the affected claims. Claims for psychotropic injectables submitted with a billing NPI that is enrolled as only a Medical Group are not experiencing this issue and can continue to be billed. When billing for psychotropic injectables, the rendering provider on the claim must be actively enrolled in CHAMPS as a physician and associated to the billing NPI on the claim.

October 26, 2009 - CHAMPS Claims Editing- Level of Care Determination (LOCD): MDCH is temporarily suspending the claims editing related to the LOCD that occurred with the implementation of CHAMPS.  This editing was the result of an unanticipated interaction between the new system and the level of care determination tool.  We are aware of the multiple issues providers are struggling with as both CHAMPS and Bridges are implemented and hope that this action will remove one of the barriers to reimbursement.  It is important, however, that providers continue to perform the LOCD according to policy and enter it in the on-line system to ensure that beneficiaries do indeed meet the medical/functional level of care requirement for reimbursement.   Notification will be issued prior to the claims editing for the LOCD being reactivated. The department will continue to work toward resolution of the implementation challenges and we thank all of you for your assistance and patience.

October 19, 2009 - MDCH has identified an issue with secondary claims paying $0 in error. Once the issue has been resolved, MDCH will be reprocessing the affected claims.

October 14, 2009 - Attention Providers: The pay cycle number on MSA [paper] Remittance Advice and electronic 835 Remittance Advice may have been incorrect for the last two pay cycles (39 and 40).  This issue will be resolved as soon as possible. In addition, during the first full pay cycle processed in CHAMPS (Pay Cycle 39), RAs were generated on several different days causing different pay dates to be listed for that week, the earliest date being 09/26/2009.  To ensure that no remittance is overlooked, providers and billing agents should use a range of pay dates to find all paid claims and remittance advices. 

October 13, 2009 - DCH has identified an issue of incorrect HIPAA Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) being reported on providers' remittance advices. The most prevalent code is CARC- 110 - (Billing date predates service date). Any questions regarding this HIPAA CARC code may be directed to the Provider Support Line at ProviderSupport@michigan.gov. MDCH is undergoing a review of all the affected CARC and RARC codes and will resolve the issue as soon as possible.

October 5, 2009 - MDCH has identified a difference in the way that the legacy MMIS system and CHAMPS reports the payment for providers that receive Medicaid Interim Payments (MIP) or are Warrant Suppressed.
 
Currently, the approved amount for any MIP or Warrant Suppressed claim lines will incorrectly show as $0.00 within the 835 and Paper RA.  For the 835, each individual line will report this approved amount within the CAS segment with Claim Adjustment Reason Code (CARC) 94, Processed in Excess of charges.  This is the only time MDCH will use CARC 94, therefore any claim that has CARC 94 within the 835 will be for a MIP or Warrant Suppressed claim.  The approved amount within the Claims Inquiry screen in CHAMPS will show the actual approved amount.
 
MDCH will be fixing this information to have it report correctly as soon as possible and will send out another update as soon as this issue is resolved.  If you have any questions, please contact Provider Support at 1-800-292-2550 or ProviderSupport@michigan.gov.

September 30, 2009 - Attention Professional Billers: In accordance with the Executive Order 2009-22, the Michigan Department of Community Health (MDCH) eliminated certain covered service benefits for Medicaid beneficiaries age 21 and older, and implemented program/fee reductions effective for dates of service on and after July 1, 2009. Currently claims that are affected by this Executive Order are denying incorrectly in CHAMPS. After the issue is resolved, MDCH will recycle all of the affected claims so that services are properly adjudicated. Please contact the Provider Inquiry at 1-800-292-2550 regarding cash flow concerns. For more information regarding the programs and services affected by Executive Order 2009-22, please refer to MSA Bulletin 09-28.

September 28, 2009 - Beginning Tuesday, September 29, 2009 the Automated Voice Response System (AVRS) service through Emdeon will no longer be available. Please contact Emdeon with questions regarding the discontinuation of this service.

September 24, 2009 - There are some remaining PDN claims in MI AuthentiCare that were exported for payment after the cutoff date of September 9, 2009. These claims will need to be resubmitted into CHAMPS. To determine if this issue applies to you, log onto CHAMPS and check your claims to identify if any of your claims are affected. If so, the affected claims will need to be resubmitted through CHAMPS.

September 17, 2009 - In preparation for the Friday, September 18th release of CHAMPS (Community Health Automated Processing System) to the public, MDCH began redirecting claims from the Legacy MMIS to CHAMPS on Monday, September 14th. MDCH has been closely monitoring CHAMPS to ensure that claims are adjudicating appropriately. Any issues are tracked and, if possible, resolved immediately. MDCH has identified and corrected an issue with some Medicaid Interim Payment (MIP) indicators. Those claims treated incorrectly will be tracked and resolved at reconciliation or settlement. 

September 16, 2009 - In preparation for the Friday, September 18th release of CHAMPS (Community Health Automated Processing System) to the public, MDCH began redirecting claims from the legacy MMIS to CHAMPS on Monday, September 14th.  MDCH has been closely monitoring CHAMPS to ensure that claims are adjudicating appropriately.  Any issues are tracked and, if possible, resolved immediately.  MDCH has identified an issue with certain void claims that providers should be aware of, though. 

As announced previously, claims that were billed in the legacy MMIS (with what is now a Rendering/Servicing-Only Individual NPI in CHAMPS) have been migrated to CHAMPS with all other paid and denied claims for historical purposes but they cannot be adjusted/replaced.  If these claims need to be adjusted/replaced, providers must first void the original claim and then rebill the claim as a new original claim with the appropriate billing and rendering NPIs.  The void process for these types of claims has not been fully automated in CHAMPS yet and is expected to be fully functional in early November. 

During the first day of adjudication in CHAMPS, MDCH staff identified a significant number of void and replacement claims that were incorrectly denied by CHAMPS for one of two reasons:  the original claim was billed with a Rendering/Servicing-Only Individual NPI. (or ) the billing NPI on the adjustment/void claim did not match the original claim because the adjustment or void claim now has a proper billing NPI though the original claim only had a Rendering/Servicing-Only Individual NPI. 

MDCH has now resolved the error that caused these claims to deny.  If a void claim is submitted for an original claim that meets this criteria, the claim will suspend until the process has been automated, at which time MDCH will force the claims back through the adjudication process.  Providers have the choice of holding back these types of void claims or submitting them now so that they will suspend until the process has been automated.

September 14, 2009 - MDCH is excited to announce that CHAMPS is now adjudicating 837 files directly. CHAMPS will not change the way that any Trading Partners submit or transfer claims. CHAMPS will communicate directly with the DEG to receive any files that have been uploaded through the DEG.

Any files submitted to the DEG September 10, 2009 through September 13, 2009 have been on hold and these will now be moved to CHAMPS. You may have originally received an accepted 997 from legacy, but now that these files will be moved into CHAMPS you will receive an additional 997.

Any new files submitted will receive the single 997 from CHAMPS. MDCH will be closely watching any new file transmissions into CHAMPS, therefore providers may not receive a 997 instantaneously.

September 10, 2009 - CHAMPS HIPAA File Submission Update: Due to the implementation of the CHAMPS system, all providers submitting 837 files will need to ensure that they are following HIPAA guidelines. Please review the updated CHAMPS HIPAA Companion Guides located on the CHAMPS website at  www.michigan.gov/MDCH >>CHAMPS>>Resources. Failure to adhere to HIPAA guidelines will result in a rejected 997 acknowledgment file.

September 10, 2009 - Migration of Legacy Suspended Claims into CHAMPS Reminder: Projected to begin October 1, 2009 MDCH will initiate the process of resurrecting all claims that rejected with proprietary edit 743 for adjudication in CHAMPS. Claims will not be recreated in CHAMPS if any of the following occur: the claim was submitted without a reported billing NPI, the rendering/servicing only NPI was incorrectly reported in the billing NPI loop/field, or the provider has not revalidated in the CHAMPS Provider Enrollment subsystem. These resurrected claims will not be available for inquiry in CHAMPS until after the projected date.

Septermber 10, 2009 -  Attention Providers: Please view this CHAMPS Go-Live informational  announcement .

September 9, 2009 - Per Policy Bulletin 09-48, as of 9/10/09 Private Duty Nurse providers will no longer be able to use MI AuthentiCare to bill Medicaid.  PDN providers must be ready to bill Medicaid directly as of September 10, 2009.  MI AuthentiCare will not be available after 9/9 at 12 midnight. 

August 11, 2009 - Please be advised: Due to the transition from the legacy Medicaid Management Information System (MMIS) to the Community Health Automated Medicaid Processing System (CHAMPS) there will be no Medical Services Administration (MSA) payments made on pay cycle 38, pay cycle date 9/23/09. Pay cycle 39, pay date 9/30/09 will include payments for both pay cycle 38 and pay cycle 39.

Hospital Medicaid Interim Payment (MIP) program payments and Quality Assurance Supplement (QAS) payments for Long Term Care Facilities that were originally scheduled for pay cycle 38 will be processed on pay cycle 37, pay date 9/16/09, a week early.

In the event that issues arise during pay cycle 39, MDCH will implement and communicate a process to mitigate the impact on providers.

August 11, 2009 - Attention: MDCH would like to remind those providers currently submitting paper claims that it is recommended that all paper claims be submitted electronically or through the Direct Data Entry (DDE) tool in CHAMPS beginning September 18, 2009. All Institutional providers must report 4 digit (leading zero) Revenue Code and Type of Bill. MDCH will no longer accept the 3 digit codes when billed.

July 30, 2009 - Please note: To access the CHAMPS system, all users must have a Single Sign-On (SSO) user ID and password. Please see the SSO instructions on how to obtain this. The Provider Domain Administrator will have responsibility of assigning rights for all other users within the organization to access the provider's file. If necessary, multiple Provider Domain Administrators may be established for a single organization but a separate application must be completed and approved for each administrator.

There are several profiles that may be assigned to each user within CHAMPS. Profiles must be established to grant access to the subsystems within CHAMPS. Users may have multiple profiles if necessary.

Below is a list of the profiles that are available for assignment only, but will not have system access until September 18, 2009:

• Domain Administrator - The ability to assign or remove domain and profile access to other CHAMPS users
• CHAMPS Full Access - Full Fee for Service access to Provider Enrollment, Prior Authorization, Eligibility, and Claims subsystems
• CHAMPS Limited Access - View only access to Provider Enrollment and full Fee for Service access to Prior Authorization, Eligibility, and Claims subsystems
• Prior Authorization Access - Fee for Service access to Prior Authorization only
• MCO Provider Access - Access to Managed Care Organization Provider Enrollment only
• Eligibility Inquiry - Fee for Service access to Eligibility only
• Provider Enrollment Access - Fee for Service full access to Provider Enrollment only
• View Provider Enrollment - View only access to Provider Enrollment
• Billing Agent Access - Access to Billing Agent Provider Enrollment only
• Claims Access - Full Fee for Service access to Claims only

J uly 30, 2009 - Please be advised: As part of the CHAMPS implementation plan, Michigan Department of Community Health (MDCH) will not allow any system changes or updates beginning August 28, 2009 through September 17, 2009.  This includes any new enrollments or modifications to existing applications as well as any Domain Administrator functions. Please be aware that all changes or modifications must be completed prior to August 28, 2009 or on or after the Go-live date of September 18, 2009.

July 29, 2009 - Please be advised: As part of the CHAMPS implementation plan, Michigan Department of Community Health (MDCH) will need to migrate all existing suspended claims within the current legacy system into CHAMPS.  To accomplish this, a phased approach will be used to reject these claims in the legacy system and later resurrect them in CHAMPS.

Beginning August 12, 2009 (Pay Cycle 32), any suspended claims that have duplicates will be rejected with:

• Proprietary edit 713 (Claim rejected as it is a duplicate of another suspended claim. Do not resubmit.)
• Claim Adjustment Reason Code (CARC) 18 and Remittance Advice Remark Code (RARC) N185

The oldest original claim will remain suspended in the legacy system. There is no need to submit a new claim.

Any remaining suspended claims in the legacy system will be rejected August 26, 2009, (Pay Cycle 34) through September 9, 2009 (Pay Cycle 26) with:

• Proprietary edit 743 (Claim manually rejected due to technical reasons._
• CARC 101 and RARC N185

As stated above, please do not resubmit these claims as they will be migrated into CHAMPS.

NOTE: Any claims submitted into the legacy system on or after August 20, 2009, if they suspend, will be automatically rejected with edit 743 and transferred into CHAMPS.

The legacy system will continue to accept and process claims during this transition period until September 9, 2009 at which time the adjudication system will be closed to prepare for CHAMPS implementation.

For further details, please refer to MDCH Numbered Letter, L 09-19, or contact Provider Support through the toll-free phone number at 1-800-292-2550 or via e-mail at ProviderSupport@michigan.gov.

July 13, 2009-  MDCH has identified a systems issue with Inpatient claims incorrectly paying Patient Status 43, 62 & 65. MDCH will be initiating claim adjustments for any claim with Patient Status 43, 62 or 65 with admit dates on/after 1/1/2007. These adjustments should appear on Pay Cycle 29 - RA 7/23/09.

June 22, 2009- As a result of Executive Order 2009-22 mandating State of Michigan furlough days, you could experience a delay in Medicaid payment. To avoid a delay, claims must be submitted one day earlier than the normal schedule. Please be aware, claims must be submitted by noon June 29, 2009 in order to appear on pay cycle 27, dated July 8, 2009.

June 16, 2009- The April 15, 2009 Biller "B" Aware message instructed providers to submit the Medicare EOB when reporting the Medicare Part C deductible in error. Submission of EOBs is only required when documenting the billing time limit, non-standard payments for traditional Medicare, or for secondary paper claims. When billing electronic claims EOBs are not required when billing Medicare Part C (Medicare Advantage or HMO) or traditional Medicare claims with standard payments. Submitting EOBs will not replace the requirement for CAS codes. Claims without appropriately completed CAS codes will be rejected.

May 12, 2009 -  Please be advised: Medicaid will no longer accept CO 42 (Contractual Obligation) for all Out Patient Hospital (OPH) Claims as this was end dated as of June 2007.  In replacement all providers should use the CO 45 when reporting Contractual Obligations.  Please make the necessary changes to all OPH claims submitted regardless of the date of service.

May 6, 2009 - Attention Rendering/Servicing Providers: Many providers billing within the professional claim format are reporting the same NPI in both the billing provider and rendering provider loops/fields.  This is not correct. If you are a rendering/servicing provider who renders services on behalf of a group, the biller MUST report the GROUP NPI (Type 2 NPI) in the billing provider loop.  Currently, within the legacy system, rendering/servicing only providers are incorrectly receiving payment. This will not happen when CHAMPS goes live, payments will stop if the claims continue to be billed incorrectly!

Within the professional claim format, providers enrolled as rendering/servicing only must report the-group NPI of the billing provider (Type 2 NPI) in Loop 2010AA , Segment NM108, Qualifier 85 for electronic claims (or) Field 33a on the CMS 1500 paper claim form.  The rendering provider (Type 1 NPI) must to be reported in Loop 2310B, Segment NM108, Qualifier 82 for electronic claims (or) Field 24J on the CMS 1500 paper claim form.

Within the dental claim format, providers enrolled as rendering/servicing only must report the group NPI of the billing provider (Type 2 NPI) in Loop 2010AA for electronic claims or Field 49 on the ADA 2006 paper claim form.  The rendering provider NPI (Type 1 NPI) has to be in Loop 2310B for electronic claims or Field 54 on the ADA 2006 paper form.

 For a list of resolved issues please view  BILLER "B" AWARE Archives .

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