Change to referring/ordering/attending editing for Medicaid claims

In accordance with the Michigan Department of Health and Human Services (MDHHS), we’ll reject claims when the referring, ordering or attending providers don’t align with bulletin MSA 21-45 for dates of service 1/1/2022 and after.

How to make sure these claims are paid

Make sure the National Provider Identifier (NPI) reported on the claim is of a provider type consistent with current licensing, scope of practice and Medicaid policy criteria.

Reference these tip sheets when filing claims:

• Institutional provider tip sheet
• FQHC/RHC/THC tip sheet

Additional information

Institutional providers

For dates of service prior to 1/1/2022, we’ll continue to reject claims when the referring, ordering or attending provider isn't a medical doctor (MD), doctor of osteopathy (DO), nurse practitioner (NP) or physician's assistant (PA).

FQHC/RHC/THC providers

Per MSA 21-47, more provider types are now allowed as attending provider on institutional claims for Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC) and Tribal Health Centers (THC) for dates of service 1/1/2022 and after.

For dates of service 4/1/2022 and after, we’ll reject Tribal Health Center claims that don’t meet the attending provider criteria.