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