CLAIMS SUBMISSION GUIDELINES

The Health Plan adjudicates both paper and electronic claims. All claims must be submitted in accordance with the policies, rules, and procedures stated in the Medicaid Provider manual unless otherwise indicated. Providers may access the HP Provider Manual for more information.

Paper Claims

Paper claims should be submitted using a either a standard CMS-1500 (08/05) or UB-04 form and mailed to: P.O. Box 30125, Lansing, Michigan 48909

Once received, claims are scanned and converted to an Electronic Data Interchange (EDI) format.

Electronic Claims

The Health Plan uses EDI for electronic submission. Currently, electronic claims are accepted through the clearinghouse Emdeon. Our payer ID is 38343. If you are currently subscribing to a different clearinghouse, you may still be able to submit electronically if a forwarding arrangement exists. For more information and complete submission instructions, click on the "Electronic Claim Instructions" link on the menu bar.

For more information and complete submission instructions click on the “Electronic Claim” link on the quick links menu.

Filing Limit

Providers may submit claims up to 365 days from the date of service to be considered for payment. Occasionally, extensions may be granted. Providers should refer to the IHP Provider Manual for more information.

Claim Completion

Form 1500

Providers must use Medicaid approved HCPCS, CPT, Revenue, ICD-9, and modifier codes when completing claims. Use of correct CHP member identification information, such as the insured’s ID (starts with the letters HPMS followed by six (6) digits) Date of birth, and spelling of member’s first and last name is also required.

Most clean claims are processed within 45 days of submission and reimbursed at State of Michigan Medicaid rates or higher.

When submitting a CMS-1500 form, the following form locators must be completed or the claim will be denied:

Form Locator 1-13, 21, and 24 – 33. Providers should refer to the CHP and to the Medicaid Provider Manual for completion instructions.

All other fields are optional.

Special attention should be given to the following form locators:
FL 1A: Member’s policy number. This number starts with the letters HPMS followed by six digits. It is not the member’s Recipient ID or Social Security number.
FL 23: Authorization number.
FL 24: Service information. Should be reported in the unshaded area. The shaded area is used to enter supplemental information which corresponds to the unshaded area.
FL 33A: Billing provider NPI. This number must be registered with the CHP prior to use and be assigned to the entity listed in box 33. Clink on “NPI information” under the quick links menu for more information.

Form UB-04

When submitting a UB-04 form, the following form locators must be completed or the claim will be denied:

Form Locator 1-28, 42-63, and 66–69. Providers should refer to the CHP and to the Medicaid Provider number for complete instructions.

All other fields are optional.

Special attention should be given to the following form locators:
FL 1: Provider’s information.
FL 2: Pay To Information.
FL 4: Type of bill. Use Medicaid approved type of bill codes.
FL 60: Member’s policy number. This number starts with the letter HPMS followed by six digits. It is not the members Recipient ID or Social Security number.
FL 56: Billing provider NPI. This number must be registered with the CHP prior to use and be assigned to the entity listed in box 1. Click on “NPI information” under the quick links menu for more information.
FL 63: Authorization number. (If Applicable)

Claims Status

Claims can be statused by phone at 1-866-291-8691, by fax at 517-394-4590, by email at planmanagement@ihpmi.org, or online 30 days after submission. To access online claim statusing, click on the Claim Status Look-up link located on the Claims Menu bar. Providers must first register for a user name and password to login. Providers may use the CHP Claim Inquiry Status form to submit their requests.


Follow IHPC:

ph: 866-291-8691

fax: 517-394-4590

planmanagement@ihpmi.org

P.O. BOX 30125
LANSING, MI 48909
© 2016 INGHAM HEALTH PLAN CORPORATION