Michigan Medicaid: How to avoid denied community health worker claims
AI Summary
Michigan FQHCs billing for community health worker (CHW) services must include specific required information on UB-04 forms to avoid claim denials. This includes modifier CG, attending and rendering NPIs, and Box 80 service descriptions, with specific rules for claim combining and qualifying visits.
Action Required
Immediately: Michigan FQHC billing teams must update UB-04 claim submission procedures for CHW services to include: modifier CG, attending NPI (Type 1 individual practitioner), rendering NPI (CHW enrolled in CHAMPS), and Box 80 service descriptions per MDHHS MMP 23-74. Ensure CHW services are combined with other same-day services on single claims and do not bill G04xx codes for CHW-only visits. Train staff on corrected claim submission procedures to avoid duplicate rejections.
Plan Types
Medicaid
States
MI
Specialties
family-medicine