Medicaid Federally Qualified/Rural/Tribal Health Centers must bill using UB-04

As of Aug. 1, 2017, in accordance with the State of Michigan, all Medicaid-approved Federally Qualified Health Centers, Rural Health Centers and Tribal Health Centers should bill all services using a UB-04 claim form.

Per diem vs. fee schedule rates

If the CPT code billed is on the qualifying clinic visit list, you will receive the clinic per diem rate. If your CPT code is not on the qualifying clinic visit list, you will be reimbursed the fee schedule rate.

Claim reprocessing updates

Update 05/04/2018:

Claim reprocessing has progressed as follows: 

  • CMS-1500 claims that paid in error were recouped as takebacks as of April 10. Providers will need to re-submit claims on a UB-04 form.
  • UB-04 claims billed without a qualifying visit were recouped as takebacks as of April 13.
  • UB-04 claims denied in error stating provider must bill on a CMS-1500: Reprocessing completed as of April 25.
  • UB-04 claims overpaid in error: The majority of claims were adjusted as of May 4. All other claims will be adjusted by Friday, May 11.
  • PO1 Missing/Invalid modifier denied claims: The majority of claims were adjusted as of May 4. All other claims will be adjusted by Friday, May 11.
  • Out-of-network claims that processed on a UB-04, billed correctly with qualifying visit, paid incorrectly: The majority of claims were adjusted as of May 4. All other claims will be adjusted by Friday, May 11.

We are still working on identifying specialist-billed claims. The majority were adjusted as of May 4. All other claims will be adjusted by Friday, May 11.

Update 03/28/2018:

We have identified claims for reprocessing as follows: 

  • CMS-1500 claims that paid in error and need to be recouped as takeback; providers need to submit on a UB-04
  • UB-04 claims overpaid in error
  • PO1 Missing/Invalid modifier denied claims 
  • Out-of-network provider claims that processed on a UB-04, billed correctly with qualifying visit, paid incorrectly
  • UB-04 claims billed without a qualifying visit and need to be recouped as takeback 

We are currently working on identifying claims for reprocessing the following:

  • Specialist billed claims 
  • UB-04 claims billed but denied in error stating must bill on a CMS-1500

Our goal is to begin reprocessing the identified claims within 45 days