Billing & payment news
Reprocessing physical therapy claims
We’re reprocessing physical therapy claims from the past few weeks due to a payment error.
June 25, 2025
RAs for May CM checks are being delivered late
Remittance advices (RAs) for our May 2025 care management (CM) payment checks are being delivered late. Checks have already been delivered.
June 25, 2025
CS modifier no longer valid
Effective July 28, 2025, claims submitted with the CS modifier will be denied. You’ll see denial code “E1J – Modifier used inappropriately” in prism.
June 25, 2025
DPP program billing reminder
Follow MDHHS billing guidelines for our Diabetes Prevention Program for Medicaid members.
June 25, 2025
May 2025 billing policy updates
We recently published or updated a series of billing policies, now available in our Provider Manual.
June 25, 2025
New and updated billing policies
Several billing policies were recently published to or updated in our Provider Manual.
June 25, 2025
Update to corrected claims goes into effect June 2
Effective June 2, 2025, all submitted claims requiring a correction – both facility and professional, regardless of any allowed / paid amount on the original claim – will require submission of a corrected claim with frequency code 7.
June 25, 2025
New and updated billing policies now available
We recently published several new and updated billing policies.
June 25, 2025
Claim dispute decisions are delivered in prism
We’re sharing a reminder that claim dispute (appeal) decisions are sent through our provider portal, prism.
June 25, 2025
We're reprocessing select doula telemedicine claims due to an error in the fee schedule
Due to a reimbursement rate error in the Michigan Department of Health and Human Services’ (MDHHS) fee schedule, we’re reprocessing doula telemedicine claims submitted under the HCPCS code S9945 between Oct. 1, 2024 and Feb. 28, 2025.
June 25, 2025
Resolving Medicaid claims rejecting incorrectly for date of death
We’re resolving an issue with some Medicaid claims rejecting incorrectly for missing or invalid date of death. We'll reprocess impacted claims; there's nothing you need to do.
June 25, 2025