Effective Jan. 1, 2018, all providers who serve Michigan Medicaid beneficiaries, including providers participating in a Managed Care Organization’s (MCO) provider network, are required to be screened and enrolled in the Michigan Medicaid program. The purpose of this requirement is to strengthen program integrity by preventing provider fraud.
MCO providers serving Medicaid beneficiaries must enroll through the Michigan Department of Health and Human Serivces’ Community Health Automated Medicaid Processing System (CHAMPS) – the state’s online Medicaid enrollment and billing system.
This change comes as part of federal regulations under the Affordable Care Act aimed at ensuring all providers who participate in Medicaid comply with federal screening and enrollment requirements. The regulations prohibit payment to providers who are not appropriately screened and enrolled.
Providers enrolling in CHAMPS are divided into two categories: typical and atypical. Typical providers are professional health care providers that provide health care services to beneficiaries. Typical providers must meet education and state licensure requirements and have assigned National Provider Identifiers (NPIs). Examples of typical provider types include, but are not limited to: physicians, physician assistants, certified nurse practitioners, dentists and chiropractors. Atypical providers provide support services for beneficiaries. These providers generally do not have professional licensure requirements, and may not have an NPI.
Beginning March 1, 2018, MDHHS will prohibit MCOs from making payments to all typical rendering, referring, ordering, operating, billing, supervising, and attending providers not enrolled in CHAMPS.
For dates of service on and after May 1, 2018, MDHHS will prohibit payment for prescription drug claims written by a prescriber who is not enrolled in CHAMPS.
Note that the timeline above applies to typical providers. MDHHS plans to start enforcing the enrollment of atypical providers in Fall 2018. MDHHS will release future updates as additional provider types become available in CHAMPS.
Enrollment in CHAMPS neither requires nor mandates those providers who are part of a managed care network to accept Fee-for-Service Medicaid beneficiaries. Enrollment in CHAMPS is solely used for the purpose of screening providers participating in Medicaid. For additional information review the notice at http://www.michigan.gov/documents/mdhhs/MSA_17-48_606931_7.pdf.
nCred is a leading national provider of healthcare credentialing services. nCred has assisted thousands of providers and healthcare organizations throughout the country with the payer provider enrollment process. The successful implementation of leading technologies combined with experienced credentialing staff produce excellent results for nCred clients. Contact us today at (423) 443-4525 or fill out our request for information form to discuss how our services can benefit your organization.