Bill Medicaid substance use disorder claims to MDHHS effective July 1, 2017

Effective July 1, 2017, you must bill all Medicaid inpatient and outpatient substance use disorder claims either directly to the Michigan Department of Health and Human Services (MDHHS)/Fee For Service Medicaid, or to the local Prepaid Inpatient Health Plan (PIHP), for payment. Claims for substance use disorder services for Medicaid patients that are billed directly to Priority Health will deny.

Go for instructions and electronic claim submission.

PIHPs may be the proper entities to pay Medicaid substance use disorder claims in some scenarios if the provider has an arrangement with the local PIHP.

Find the correct PIHP

Each county has their own PIHP that needs to be billed based on the member's residing county. The list of all PIHPs and regions can be found here:

Below are links to the Medicaid Provider Manual page on substance use disorders and on acute detoxification:

Coding help

The specific code set to be billed to the proper PIHP can be found by logging into CHAMPS:

  1. Go to the External Links menu located on the 'Provider Portal' page.
  2. Select 'Medicaid Code and Rate Reference' from the dropdown list.

Claims from Jan. 1 forward will be recouped

Any Medicaid substance use disorder inpatient claims Priority Health paid between Jan. 1, 2017 and now will be recouped, and providers will be advised to bill the proper PIHP instead.