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

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.

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

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

Updates: Issues: 1)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.

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.

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 Claim Limit list to view duplicate claim TCN.

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.

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

Updates CHAMPS Updates can be found at: click CHAMPS scroll down to CHAMPS Provider Update Table

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

CHAMPS Resources For CHAMPS Navigation issues: CHAMPS Helpline: or For Billing Questions: Provider Inquiry: or