Billing & Reimbursement
BCCCP, WISEWOMAN and MCRCEDP

12/22/2011 - In accordance with HIPAA standards, effective January 1, 2012, providers utilizing electronic claim submission must submit electronic 837P and 837I claims files using the X12 version 5010. While the new claim format accommodates the ICD-10 codes, ICD-10 codes will NOT be accepted as part of the 5010 project.

  • New File Name (Application ID):  5495
  • 999 Acknowledgment files will be available
  • 835 file name will remain the same = 5469, but will be in 5010 format

* Application ID (File Name): 5495
Interchange Receiver ID: D00111

Loop 1000B, Segment NM103 – ‘BCCCP’
Loop 1000A, Segment NM109 - '00_ _' (example:  DCH00AB)
Loop 1000B, Segment NM109 – ‘D00111’

11/07/2011 - EDI TEXT files now available for agencies unable to utilize the EDI x12 835 files.

Agencies must have access to DEG (Data Exchange Gateway) with a user name and password.

If an agency does NOT have a DEG user name/password, please contact Tory Doney at 517-335-8854 or email her at DoneyT@michigan.gov. Please have the following information available:

  1. Agency Name
  2. Agency Federal Tax ID
  3. Contact Name
  4. Contact Phone #
  5. Contact Fax #
  6. Contact Email Address

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5/26/2011 - Please send ALL paper claims to MDCH - Claims, 109 Michigan Ave, WSB - 5th Floor, Lansing, MI 48913. No claims, regardless of date of service, should be sent to McLaren/Health Advantage.

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CLAIMS PROCESSING CHANGES: BCCCP, WISEWOMAN and Colorectal claims will be processed by the State of Michigan (SOM) via the Data Exchange Gateway (DEG).

**Health Advantage, Inc. will no longer be utilized as our third party administrator (TPA).

The DEG is basically an electronic P.O. box for our program to receive electronic claims (know as 837 files) and for your agency to retrieve electronic payment remittances (known as 835 files). Electronic Funds Transfer (EFT) will be available for those agenices wishing to participate.

All agencies that provide services for our clients will need to have a DEG mailbox OR use an affiliated clearinghouse (Netwerkes, Emdeon, etc.).

* If you do not use a clearinghouse and are unsure if you have a DEG mailbox, please fill out the DEG Information Request Form and fax it to Tory Doney at 517-335-8752.
*All agencies have been asked to fill out the form, regardless of use of a clearinghouse.*

Following are the addresses for paper and electronic claims filing:

PAPER Claim Submission ~ Paper Claim Guidelines
MDCH – Claims
109 Michigan Ave
WSB – 5th Floor
Lansing, MI 48913

ELECTRONIC Claim Submission ~ Data Exchange Gateway (DEG)

* Application ID (File Name): 5495
Interchange Receiver ID: D00111

Loop 1000B, Segment NM103 – ‘BCCCP’
Loop 1000A, Segment NM109 - '00_ _' (example:  DCH00AB)
Loop 1000B, Segment NM109 – ‘D00111’

MEMOS, FORMS, USER GUIDES & MANUALS

  • EFT Manual - Business - Vendor & Payee Registration
  • EFT Manual - Individual - Vendor & Payee Registration

Last Updated 12/22/2011