Michigan Medicaid Providers Must Be Screened and Enrolled Effective January 1

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Starting January 1, all providers who see Michigan Medicaid beneficiaries must be screened and enrolled in the Michigan Medicaid program.

This requirement includes those providers participating in a Managed Care Organization's provider network. These must enroll through the Michigan Department of Health and Human Services' online Medicaid enrollment and billing system known as Community Health Automated Medicaid Processing System (CHAMPS).

The change is part of federal regulations under the Affordable Care Act and is intended to strengthen program integrity by preventing provider fraud. Its intent is to ensure that all providers participating in Medicaid comply with federal screening and enrollment requirements. Regulations prohibit payment to providers who have not been appropriately screened and enrolled.

Compliance Timeline Differs Based on Provider Type

Those providers enrolling in CHAMPS form 2 categories:

  • Typical providers are professional health care providers that provide health care services to beneficiaries. They must meet education and state licensing requirements. They must also have assigned National Provider Identifiers (NPIs) and include, for example, physicians, physician assistants, dentists and certified nurse practitioners.
  • Atypical providers provide support services for beneficiaries. They may not have NPIs and generally do not have professional licensing requirements.

The Michigan Department of Health and Human Services will prohibit Managed Care Organizations from making payments to all typical providers not enrolled in CHAMPS beginning March 1, 2018. For service dates on and after May 1, payment for prescription drug claims written by a prescriber who is not enrolled in CHAMPS will be prohibited.

The enrollment of atypical providers will be enforced beginning in fall 2018.

You can read more about these requirements in this MDHHS bulletin and the MDHHS Provider Enrollment webpage.

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.