State · MI
Medical billing services in Michigan
Short answer
Medical billing services in Michigan answer to two clean claim laws instead of one: MCL 500.2006 for commercial health plans and MCL 400.111i for the plans that carry Medicaid, each with a 45-day payment clock and 12 percent interest on a late clean claim.
Fee-for-service claims have to reach CHAMPS and get a TCN within 12 months of the date of service, nine Medicaid Health Plans divide the state by Prosperity Region, and an out-of-network clinician in a surprise billing case has 60 days to file. A Remitwright dedicated biller works those rules, serving Michigan practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in Michigan: what's different
The rules below change how a claim is filed and paid in Michigan. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In Michigan | Source |
|---|---|---|
| Medicaid program | Michigan MedicaidMichigan Department of Health and Human Services (MDHHS) | 1 |
| Fee-for-service portal | CHAMPS (Community Health Automated Medicaid Processing System) | 1 |
| Managed care plans | 9 plansAetna Better Health of Michigan, Inc., Blue Cross Complete of Michigan, LLC, HAP CareSource, Inc., McLaren Health Plan, Inc., Meridian Health Plan of Michigan, Inc., Molina Healthcare of Michigan, Inc., Priority Health Choice, Inc., United Healthcare Community Plan, Inc., Upper Peninsula Health Plan, LLC | 2 |
| Medicaid timely filing (fee-for-service) | 12 months from the date of service | 1 |
| Prompt-pay law | MCL 500.2006(8), Michigan Insurance Code | 4 |
| NEMT | Three routes | 1 |
| EVV | Open vendor model | 10 |
Michigan Medicaid
Michigan Medicaid is run by the Michigan Department of Health and Human Services (MDHHS). Fee-for-service claims and provider enrollment go through CHAMPS (Community Health Automated Medicaid Processing System)1, at milogintp.michigan.gov. Nine Medicaid Health Plans, each awarded one or more of the state's 10 Prosperity Regions, cover members of Medicaid and the Healthy Michigan Plan under MDHHS health plan contracts that took effect October 1, 20242. The Upper Peninsula (Region 1) has a single plan, Upper Peninsula Health Plan, while the Detroit Metro region (Region 10) has eight. The contracts run five years with three optional one-year extensions.
Fee-for-service filing limit: 12 months from the date of service for MDHHS to receive the claim and assign it a Transaction Control Number (TCN) in CHAMPS, and every claim must be resolved within one year of the date of service unless an exception applies1. On institutional claims the date of service is the through date. If eligibility is made retroactive less than 12 months after the date of service, MDHHS takes the claim up to six months after the retroactive determination, with "timely filing" written in the claim comments. Retroactive provider enrollment does not count as an exception. Managed care plans set their own limits in their provider manuals, so the deadline on a Michigan Medicaid claim depends on which plan holds the member on the date of service.
Managed care plans2
- Aetna Better Health of Michigan, Inc.Regions 7 to 10
- Blue Cross Complete of Michigan, LLCRegions 2 to 6, 9 and 10
- HAP CareSource, Inc.Regions 6, 7, 9 and 10
- McLaren Health Plan, Inc.Regions 2 to 10
- Meridian Health Plan of Michigan, Inc.Regions 4, 5, 6, 8, 9 and 10
- Molina Healthcare of Michigan, Inc.Regions 2 to 6 and 10
- Priority Health Choice, Inc.Regions 2, 3, 4 and 10
- United Healthcare Community Plan, Inc.Regions 4, 6, 7, 8, 9 and 10
- Upper Peninsula Health Plan, LLCRegion 1
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Michigan Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in Michigan7: Blue Cross Blue Shield of Michigan, Blue Care Network of Michigan, Priority Health, Health Alliance Plan (HAP), Meridian Health Plan of Michigan, UnitedHealthcare, Molina Healthcare of Michigan, Alliance Health and Life Insurance Company. Each has its own filing window, corrected-claim process and appeal levels in its provider manual, and the timely filing limits table lists verified payer deadlines with their sources.
Clean-claim payment window under MCL 500.2006(8), Michigan Insurance Code: 45 days after the plan receives a clean claim, with 12 percent simple annual interest on a clean claim paid late4. The plan has 30 days from receipt to tell the provider every known reason the claim is not clean; the provider then has 45 days to fix it, and the payment clock stops while the fix is pending. A claim only counts as clean if it is billed within 1 year of the date of service or discharge. The section does not reach administrative services only or cost-plus arrangements, so a self-funded employer plan falls outside it, and complaints go to the DIFS director. For a Michigan practice, the statute does its work in A/R follow-up: a clean claim still unpaid after the window is escalated with the statute cited, and interest is requested where the law provides it.
NEMT and home care in Michigan
Non-emergency medical transportation. Three routes. Medicaid Health Plans and HIDE SNPs provide rides for their own enrollees to all Medicaid-covered services; for fee-for-service members, local MDHHS offices authorize NEMT in every county except Wayne, Oakland and Macomb, where a contracted broker, ModivCare Solutions (formerly LogistiCare), administers it1. The plans may set prior authorization and documentation rules that differ from the fee-for-service chapter. A special allowance, such as a wheelchair lift-equipped vehicle, a Medi-Van or an attendant, needs a completed Medical Verification for Transportation (DHS-5330) kept in the beneficiary's file. The NEMT billing in Michigan page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. Open vendor model: HHAeXchange provides the state EVV system and aggregator, which providers and managed care organizations can use at no cost, or they can use an alternate EVV system that integrates directly with the state system10. MDHHS contracted HHAeXchange for data collection, data aggregation and a pre-billing module, and HHAeXchange consolidates every visit whatever EVV tool recorded it. The 21st Century Cures Act requires EVV for Medicaid personal care and home health services that involve an in-home visit. See home care billing in Michigan for waiver programs, EVV exceptions and authorizations.
Rules that change how Michigan claims are billed
Surprise billing claims have their own 60-day deadline under MCL 333.245076
When an out-of-network clinician treats an emergency patient, or treats a nonemergency patient at an in-network facility without the patient having a chance to choose an in-network provider or receiving the required disclosure, the claim must reach the patient's carrier within 60 days of the service. Payment in full is the greater of the carrier's median negotiated amount for the region and specialty or 150 percent of the Medicare fee schedule, the carrier must pay within 60 days of receiving the claim, and the patient owes only the in-network cost sharing. The rule also covers the whole hospital stay when an emergency patient is admitted within 72 hours of the emergency room visit.
Medicaid health plans answer to MCL 400.111i, with an external review5
The Social Welfare Act sets a parallel clean claim procedure for the plans that pay Medicaid claims. You bill within 1 year of the date of service or discharge, the plan pays a clean claim within 45 days or adds 12 percent simple interest, and it must state any defect in writing within 30 days. You then have 30 days to correct the defect and the plan pays within 30 days of the correction. If the claim comes back still defective, you can ask the commissioner for an external review within 30 days of that notice, and a plan cannot deny a whole claim because one line is defective or not covered.
Telemedicine takes the in-person place of service plus modifier 95 or 931
Michigan Medicaid wants a professional telemedicine claim coded with the place of service that would apply if the patient were in the room, plus modifier 95 for audio and video or modifier 93 for audio-only. POS 02 or 10 is the exception, used by virtual-only providers, PSYPACT psychologists and PIHP or CMHSP encounters. A home originating site earns no telehealth facility fee, and a telemedicine provider tied to a billing provider outside Michigan needs prior authorization unless policy says otherwise.
Mental health billing splits between the health plan and the PIHP1
The Medicaid Health Plan covers outpatient mental health care in office and clinic settings for enrollees with mild to moderate mental illness, or whose severity has not been determined yet, including screening. Specialty behavioral health services run through the Prepaid Inpatient Health Plans and community mental health services programs, which authorize them and follow their own telemedicine database, so the payer is confirmed before the first visit.
CHAMPS enrollment is revalidated at least every five years1
Every provider revalidates its Michigan Medicaid enrollment at least once every five years, or sooner when MDHHS asks, and must report any change to enrollment information within 35 days. Every staff member who works in CHAMPS needs a personal MILogin user ID, and the organization's Provider Domain Administrator assigns each user's access to the provider file. Individual physicians and non-physician practitioners pay no application or revalidation fee; institutional providers do, unless they have already paid it to Medicare or another state's Medicaid or CHIP.
Services for Michigan practices
Remitwright serves Michigan practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from Michigan practices
What is the Michigan Medicaid timely filing limit?
Our Medicaid health plan claims sit for weeks. Does Michigan set a payment deadline for them?
We saw an out-of-network patient in an in-network hospital's emergency room. What can we collect?
How do we code a telemedicine visit for Michigan Medicaid?
A patient with a serious mental illness needs therapy. Who do we bill?
Who arranges NEMT rides to our clinic for Medicaid patients in Michigan?
When did EVV start for Michigan home care, and which system do we use?
Which managed care plans run Medicaid in Michigan?
Who runs Medicaid in Michigan, and where do fee-for-service claims go?
Next step
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