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MedicaidAdministrativeMedium impact

Michigan Medicaid: How to avoid denied community health worker claims

UnitedHealthcare·MI · Family Medicine·State news
Effective date
Not stated
We identified it
Apr 1, 2026
Days to comply
—

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

Action needed
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.

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