01Already effective October 1, 2016: CPT 69220 is covered for physicians, practitioners and medical clinic providers for dates of service on and after that date.
02Providers must bill the automobile insurance carrier before billing Medicaid or the Medicaid managed care plan, and Medicaid or the plan must be billed within six months from the date of filing the no-fault claim to keep the claim active.
03Pharmacies may request an override from the MDHHS PBM Technical Call Center for an early refill that is warranted, because non-controlled substance refills for FFS beneficiaries are not allowed until at least 75 percent of the drug quantity limit has been consumed.
04Nurse practitioners who render services to Medicaid beneficiaries must enroll as either a Rendering/Servicing-Only Provider or an Individual/Sole Provider.
05Services by limited licensed psychologists, social workers, professional counselors, marriage and family therapists or student interns must be performed under an enrolled, fully-licensed provider of the same profession, and are billed under that supervising provider's NPI, which must be uniquely identified on all claims.
06Requests for prior authorization of surgeries, procedures, office-administered pharmaceuticals, biologicals and out-of-state care must use form MSA-6544-B, completed in its entirety with supportive medical documentation, and the PA number is documented for the claim.
07Ambulance providers must request prior authorization from the MDHHS Program Review Division, may not bill MDHHS for prior authorized services until the request is approved, and must enter the PA number on the claim before reimbursement.
08MDHHS will not reimburse private duty nursing services that have not been prior authorized, and the service log must be beneficiary specific and kept in the beneficiary's record, with failure to maintain it potentially resulting in recoupment.
09Family Supports Coordination face-to-face assessment visits are billed with HCPCS T2024 and face-to-face monitoring visits with HCPCS T1017, with a maximum of five monitoring visits per year per family or household and prior authorization required for additional visits.
10check current applicability in the current Michigan Medicaid Provider Manual rather than completing these past changes.