champs presentation school based services liaison meeting february 25, 2010 lisa trumbell, provider...

CHAMPS PresentationSchool 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 www.mihealth.org

• 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 identifiedas our insured.- Benefit plan & Procedure code identification issue. Procedure excluded from Benefit plan in error. Claims processing to correct as this edit appears.

UpdatesIssues:

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:

www.michigan.gov/mdch 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: www.michigan.gov/mdch click CHAMPS scroll to Medicaid Provider Training

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