Billing -
Electronic and Paper Claim
Submission
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’
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.).
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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
- 3/11/2011 - TPA and Claim Processing Change
- DEG Information Request Form - Please fill out and fax to (517) 335-8752
- EFT Manual - Business - Vendor & Payee Registration
- EFT Manual - Individual - Vendor & Payee Registration
Last Updated 04/08/2013