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CHAMPS Presentation School Based Services Liaison meeting

CHAMPS Presentation School Based Services Liaison meeting. February 25, 2010 Lisa Trumbell, Provider Liaison Lynn Hicks, Provider Support. CHAMPS. Replaces old system Functions: Check Eligibility Enter claims on-line (Direct Data Entry) On-line Claim adjustments/voids Status claims.

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CHAMPS Presentation School Based Services Liaison meeting

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  1. CHAMPS PresentationSchool Based Services Liaison meeting February 25, 2010 Lisa Trumbell, Provider Liaison Lynn Hicks, Provider Support

  2. CHAMPS • Replaces old system Functions: • Check Eligibility • Enter claims on-line (Direct Data Entry) • On-line Claim adjustments/voids • Status claims

  3. 835 reporting old HIPAA Format • 835 now reporting on the correct HIPAA Format: 4010X091-A1 • Unique Identifier not reporting or reporting inconsistently on the 835. Defect filed 2/22/10.

  4. CHAMPS Eligibility • Benefit Plan should = MA (Medicaid Fee-For-Service) • If Eligibility returns: MC-MA (Medicaid Managed Care) it must also have MA listed as a separate Benefit Plan

  5. Eligibility Duplicate ID’s: • MPHI will post a toll free number on www.mihealth.org • Toll Free number customer service representatives specialized in assisting w/ duplicate ID corrections

  6. Updates: Issues: • V2799 Vision Services Misc rejecting for Prior Auth. Required. This code does not Require PA. Scheduled for 2/26/10 release. 2) Reason code 31: Patient Cannot be identified as our insured. - Benefit plan & Procedure code identification issue. Procedure excluded from Benefit plan in error. Claims processing to correct as this edit appears.

  7. Updates Issues: 3) Diagnosis code does not support Procedure code: Affected all codes. Claims pending. Status: Corrected. Dx codes now loaded. MDCH to release the pended claims.

  8. Updates: Issues: 4) Reason Code 18 Exact Duplicate Resolution: Inquire on claim in CHAMPS using TCN, click TCN hyperlink, click claim line hyperlink, in show menu select ClaimLimit list to view duplicate claim TCN.

  9. Updates Issue: 5) Remark Code: 204 Service/equipment/drug not covered under patient’s benefit plan. Resolution: Confirm beneficiary has MA as a benefit plan. Confirm procedure code in SBS fee screen.

  10. Updates Issue: 6) T1024 Team Eval. & Management Rejecting incorrectly w/ Reason Code: 204 Status: MDCH reviewing

  11. Updates CHAMPS Updates can be found at: www.michigan.gov/mdch click CHAMPS scroll down to CHAMPS Provider Update Table

  12. SBS Training • SBS specific billing & CHAMPS training in June, 2010 (Date, location TOB) • Navigational Sessions (TOB) • Visit: www.michigan.gov/mdch click CHAMPS scroll to Medicaid Provider Training

  13. CHAMPS Resources For CHAMPS Navigation issues: CHAMPS Helpline: 1-888-643-2408 or champs@michigan.gov For Billing Questions: Provider Inquiry: 1-800-292-2550 or providersupport@michigan.gov

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