Health care providers that serve Medicaid beneficiaries are facing an upcoming enrollment deadline that is necessary for them to continue to receive payments from Medicaid.
While the Michigan Department of Health and Human Services (MDHHS) has revised the timeline to give providers more time to enroll, the department is urging providers to complete the screening and enrollment process as soon as possible.
For dates of service on or after Jan. 1, 2019, MDHHS will prohibit contracted Medicaid Health Plans and Dental Health Plans from making payments to typical providers not actively enrolled in Community Health Automated Medicaid Processing System (CHAMPS) – the state’s online Medicaid enrollment and billing system.
Typical providers are health care professionals that provide health care services to beneficiaries. They must meet education and state licensing requirements and have assigned National Provider Identifiers. Examples include, but are not limited to, physicians, physician assistants, certified nurse practitioners, dentists and chiropractors.
At this time, contracted Integrated Care Organizations (ICOs), Prepaid Inpatient Health Plans (PIHPs) and MI Choice Waiver agencies are exempt from this requirement. CHAMPS enrollment neither requires nor mandates providers in a managed care network to accept Fee-for-Service Medicaid beneficiaries. CHAMPS enrollment is used solely to screen providers participating in Medicaid.
For dates of service on or after July 1, 2019, MDHHS Fee-for-Service and Medicaid Health Plans will prohibit payment for prescription drug claims written by a prescriber who is not enrolled. More details on prescriber enrollment will be forthcoming early in 2019.
The federal Affordable Care Act and the 21st Century Cures Act require all providers who serve Medicaid beneficiaries to be screened and enrolled in the state Medicaid enrollment system. The purpose of this requirement is to protect beneficiaries by strengthening program integrity and care quality.
For information about the Provider Enrollment process and how to get started, visit michigan.gov/MedicaidProviders and click on “Provider Enrollment.”