1. 2018 Michigan Rural Health Conference
May 3,2018

2. Agenda Review of MSA 17-10 Procedure Code T1015
Medicaid Primary Reporting
Medicaid Secondary Claims
Reporting to the Managed Care Plans
System Fixes/System Defects
Provider Resources

3. MSA (Revised MSA 17-24)
Institutional Clinic Billing

4. MSA (Revised MSA 17-24)
MSA was issued pushing back the implementation of to August 1, 2017
MSA also made clarification that the MIHP and MICare programs are not effected by MSA 17-10
All services rendered in the RHC clinic must be billed on the UB to receive proper claim adjudication.
T1015 is to be used by RHC’s only as the Visit Code where reimbursement will be made

5. Procedure Code T1015
Institutional Clinic Billing

6. Procedure Code T1015
T1015 is to be used by all RHC provider in order to receive proper reimbursement
T1015 should only be reflected on those claims that reflect a face to face visit, and eligible for an encounter.
The proper revenue codes must be illustrated along with the Visit Code and Qualifying Visit Codes
When claim reimbursement is made the PPS rate will only be reimbursed on the T1015, with the Qualifying Visits paying at $0.00

7. Medicaid Primary Reporting
Institutional Clinic Billing

8. Medicaid Primary Reporting
There are 3 ways that the T1015 can be reported on a Medicaid Primary claim
Which ever way the T1015 is reported the reimbursement on the claim will only be paid on the T1015, resulting in the qualifying visit paying at $0.00
T1015 can be reported at $0.00 with the cost reported at the qualifying visit line
T1015 can be reported with all cost associated to the qualifying visit lines rolled up.
T1015 can be reported with $0.01, to follow Medicare

9. Medicaid Secondary Reporting
When reporting the T1015 on a Medicaid secondary claims it will more then likely be reported 1 of 2 ways
T1015 can be reported at $0.00-this is how Medicare wants the T1015 reported and will allow for a proper Medicare crossover
T1015 can be reported at $0.00, if the T1015 needs to be added to a commercial insurance primary claim.

10. Reporting T1015 to the Managed Care Plans
T1015 is required to be reported to the HMO’s as well.
T1015 should only be reported on those claims that count as an encounter.
We have heard that some HMO’s are requiring the T1015 even on claims that are not encounters. We are working with the HMO’s to get this straitened out.
The HMO’s are not paying the PPS Rate but instead they are paying either:
The FFS fee screen rates
Suggested Managed Care rates
Rate within the contract between the HMO and the clinic

11. System Fixes/System Issues
Institutional Clinic Billing

12. Provider Resources MDHHS website: www.michigan.gov/medicaidproviders
We continue to update our Provider Resources, just click on the links below:
Listserv Instructions
Medicaid Alerts and Biller “B” Aware
Quick Reference Guides
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Provider Support: or
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