Michigan Medicaid: How to avoid denied community health worker claims
AI Summary
Michigan Medicaid requires specific information on UB-04 forms for community health worker (CHW) services to avoid claim denials. FQHCs must include modifier CG, attending NPI, rendering CHW NPI, and Box 80 service descriptions, with CHW enrolled in CHAMPS system.
Action Required
Immediately: Billing teams at Michigan FQHCs must update UB-04 claim submission processes to include: 1) Modifier CG for all CHW services, 2) Attending NPI (Individual Type 1 practitioner), 3) Other/Rendering NPI for CHW enrolled in CHAMPS, 4) Box 80 service descriptions per MMP 23-74. Do not submit CHW services on separate claims if other services performed same day. Do not bill G04xx codes with CHW-only services. Submit corrected claims (not duplicates) for previously processed claim fixes. Failure to include required information will result in claim denials.
Plan Types
Medicaid
States
MI
Specialties
family-medicine, internal-medicine, general-practice, pediatrics