Michigan Medicaid

Due to system maintenance, the following web applications will be unavailable for approximately 30 minutes between Sunday, November 22, 11pm ET and Monday, November 23, 6am ET: UAC, Web PA, Web RA, Pharmacy Web Claims Submission, Virginia ARS Web Inquiry, Nevada EVS Web Inquiry and FirstHCM/OPAS. We apologize for any inconvenience this may cause.

To view October 2009 MPPL & PDL changes click here.

October 2009

Reimbursement for Administration of H1N1 Vaccines by Pharmacies

Effective September 30, 2009, in an effort to improve access to the 2009 Influenza A (H1N1) monovalent vaccine, the Michigan Department of Community Health (MDCH) will begin reimbursing eligible pharmacies to administer this vaccine to Medicaid, ABW, MOMS, and CSHCS beneficiaries. View additional details in the MSA Bulletin 09-52. If you have any billing questions, please contact the FHSC Technical Call Center at (877) 624-5204.

September 2009

Automated Voice Response System

Emdeon informed the Michigan Department of Community Health that the Automated Voice Response System (AVRS) at 888-696-3510 will be decommissioned effective Tuesday, September 29th. Providers without internet access needed to utilize one of the web-based eligibility verification systems can still contact the CHAMPS HelpLine at 888-643-2408.

Provider Eligibility Verification Assistance

Michigan Department of Community Health providers should contact the CHAMPS Helpline at 888-643-2408 with questions about verifying eligibility through the MI Healthplan Benefits (MPHI), Emdeon, Netwerkes, web-DENIS or CHAMPS web-based systems. Click here for instructions on how to update your pharmacy access profile should you experience any difficulties with MI Healthplan Benefits (MPHI) web-based eligibility verification. Click here to view bulletin on Pharmacy Beneficiary Eligibility Verification

CSHCS Beneficiary Eligibility Issues

It has been brought to the Department's attention that there is a system issue that is preventing new CSHCS eligibility data from being reflected in the eligibility verification systems. As a result, pharmacy claims for some beneficiaries (i.e. those with new or recently renewed eligibility) may deny when billed to First Health or CHAMPS. Pharmacies may contact CSHCS at 517-241-7186 and ask for billing resolution assistance with this temporary problem Monday through Friday. CSHCS beneficiaries experiencing an eligibility issue can contact the CSHCS Family Line at 1-800-359-3722 Monday through Friday for further assistance. Thank you for providing your usual assistance with urgent needs over weekends.

August 2009

CHAMPS Training for Pharmacy Providers

The Community Health Automated Medicaid Processing System (CHAMPS) will be the new Michigan Medicaid claims system. As stated in MSA Bulletin 09-30, the Eligibility and Enrollment, Prior Authorization, Claims and Encounters, and Contracts Management Subsystems will be launched effective September 18, 2009. Pharmacy providers will be using the CHAMPS Eligibility and Enrollment Subsystem.

CHAMPS Training is available at www.michigan.gov/mdch >>> CHAMPS box (lower left side) >>> CHAMPS Training (lower right side). Prior to attending one of the training sessions, please register for a SSO User ID and Password. Click here for instructions on how to register for a user ID.

July 2009

Pharmacy NPI

Beginning 07/29/2009, a claim submitted with a pharmacy's NPI as the Prescriber ID will reject as NCPDP 25 - Missing/Invalid Prescriber ID.

Note: For condom claims, MDCH will continue to allow the submission of the pharmacy's NPI in the Prescriber ID field. Condom claims will not reject in this instance.

Mailing Discrepancy: 07/01/2009 Pending Reversal/Void Mailing

MDCH discovered that there were some errors in the recent July 1, 2009 mailing to pharmacy providers being notified of their Pending Pharmacy Reversal/Voids. If your pharmacy received this July 1st, 2009 mailing, please disregard it. A replacement report, dated July 9, 2009, has been sent out.
We apologize for any inconvenience this may have caused.
If you have questions please send your question(s) Department's Third Party Liability Division via fax to the (517) 335-9422, or e-mail to constabled@michigan.gov

June 2009

Dispensing Fees

Effective July 1, 2009, the Michigan Department of Community Health is required to reduce the pharmacy provider dispensing fees back to the rates in effect prior to the April 1, 2009 increases. For additional information about this change and other Medicaid reductions resulting from Executive Order 2009-22, please refer to the MSA-09-28 Provider Bulletin. Click here to view bulletin.

To view July 2009 MPPL & PDL changes click here.

March 2009

Co-pay Level Changes

The Michigan Department of Community Health (MDCH) received notification of upcoming drug database updates that will change the co-pay levels of select products for our program beneficiaries. The B 09-02 letter was sent to beneficiaries that may be affected by an increase in certain medicine co-pays.

To view April 2009 MPPL & PDL changes click here.

February 2009

Pharmacy Eligibility Verification Alternative

The Michigan Department of Community Health (MDCH) recently issued Policy Bulletin MSA 09-04 announcing the elimination of the free phone Automated Voice Response System (AVRS) to verify beneficiary eligibility as a result of Executive Order 2008-21. MDCH providers, including pharmacies, were directed to a free alternative using web-DENIS. MDCH has now been informed that some pharmacies (i.e. those not also enrolled as DME/Medical Suppliers with MDCH) may experience difficulty being granted web-DENIS access due to Blue Cross internal policies/procedures. We sincerely apologize for the inconvenience. In lieu of web-DENIS the MDCH has made arrangements for another free web-based alternative for pharmacy providers through the Michigan Public Health Institute (MPHI). Please click here for additional details. Your National Provider ID (NPI) must be submitted on the access form.

Mailing Discrepancy: 02/02/2009 Pending Reversal/Void Mailing

MDCH discovered that there were some errors in the recent February 2, 2009 mailing to pharmacy providers being notified of their Pending Pharmacy Reversal/Voids. If your pharmacy received this February 2, 2009 mailing, please disregard it. We apologize for any inconvenience this may have caused. If you have questions please send your question(s) via fax to the Department's Third Party Liability Division at (517) 346-9817 or (517) 335-9422. Click here to view the provider letter. Click here to view the void report sample.

To view January 2009 MPPL & PDL changes click here.

November 2008

System Down Time

Due to scheduled maintenance the Michigan Point of Sale System will be down from 10pm on November 22 until 7am on November 23rd.

Checks delayed after Thanksgiving

Due to the upcoming Thanksgiving Holiday, pharmacy provider checks will be delayed until Tuesday 12/02/2008 instead of the normal Monday release.

Pharmacy Provider Re-Enrollment Process

All pharmacy providers who serve beneficiaries of MDCH must re-enroll by March 01, 2009 in order to avoid delays in claim processing.

A Pharmacy Re-Enrollment Profile Application (MSA-1626-R) containing the current information on your Trading Partner Agreement will be mailed to you on 12/01/08. Please review and make any needed changes to the Pharmacy Re-Enrollment Profile Application (MSA-1626-R) as well as complete any blank fields, sign and return to FHSC by 02/02/09. A confirmation fax will be sent once the updated Pharmacy Provider Revalidation Profile Application (MSA-1626-R) has been successfully processed. Please call FHSC Provider Enrollment Unit at 804-965-7619 or 804-965-7748 with any questions.

To view September 2008 MPPL & PDL changes click here.

September 2008

Provider Reversal Notification - Update

As a result of concerns regarding a recent provider reversal notification dated September 16, 2008 (click here to see the notice), the Michigan Department of Community Health will NOT be requiring pharmacies to take action on the claims until further instructions are provided. We apologize for any confusion.

Notice on Infusion drug type edit

It was noted during a recent review that claims are being submitted with a PAMC code of "8", which indicates an infusion claim, that include drugs that are not suitable for infusion preparations. Effective 08/29/2008 First Health will deny claims submitted with a PAMC of 8 if the route of administration of the drug is not suitable for infusion preparation, such as "oral", "rectal", "topical", etc. If the provider feels that the denial is in error, they may call the First Health clinical call center and discuss the claim with a First Health representative.

To view July 2008 MPPL & PDL changes click here.

June 2008

Heparin Recalls

Please help FDA spread the word about recalls of injectable heparin products and heparin flush solutions that may be contaminated with oversulfated chondroitin sulfate (OSCS). Affected heparin products have been found in medical care facilities in one state since the recall announcement. Although product recall instructions were widely distributed, they may not have been fully acted upon at all sites where heparin is used. There have been many reports of deaths associated with allergic or hypotensive symptoms after heparin administration (see FDA link).

May 2008

NPI Cut over

Effective May 23, 2008, the Michigan Department of Community Health will only accept the NPI numbers for the Service Provider and the Prescriber ID. This requirement applies to all Michigan Governors Program (MiRx Prescription Drug Discount Card) claims submitted to First Health. When submitting claims using the NPI, Pharmacy Services providers are reminded to use the Service Provider ID qualifier of '01' in NCPDP field number 202-B2 and the Prescriber ID qualifier of “01” in the NCPDP field number 466-EZ. Claims that are not submitted with the service provider NPI will deny for NCPCP 05- M/I Pharmacy Number. And claims that are not submitted with the prescriber NPI will deny for NCPDP 25- M/I Prescriber ID.

FIELD	NAME OF FIELD	VALUE
2Ø1-B1	Service Provider ID	10 Digit NPI number (Pharmacy)
2Ø2-B2	Service Provider ID Qualifier	Ø1 = National Provider ID (NPI)
411-DB	Prescriber ID	10 Digit NPI number (Prescriber)
466-EZ	Prescriber ID Qualifier	Ø1 = National Provider ID (NPI)

April 2008

Unit of Measure Requirement

Effective 05/01/2008, MDCH will require the submission of the Unit of Measure (NCPDP Field 6ØØ-28). Claims without the Unit of Measure will reject with NCPDP 26 - Missing/Invalid Unit of Measure. In addition, the submitted Unit of Measure must match the national drug code's Drug Form reported by First Databank otherwise the claim will reject with NCPDP PZ - Non-matched Unit of Measure. Click here for the MSA 08-05 Policy Bulletin regarding this new requirement.

To view changes to drug coverage from March 2008 P&T Meeting click here.

March 2008

Tamper Resistant Prescription Pads

Effective 04/01/2008, Michigan Medicaid is mandated to require tamper resistant prescription pads in accordance with the federal law, U.S. Troop Readiness, Veteran's Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007 (Public Law 110-28). Michigan Medicaid policy bulletin MSA 08-03 provides the Center for Medicare & Medicaid Services' (CMS) guidelines related to the use of the tamper resistant prescription pads for the Medicaid Program. An FAQs guide is available at http://www.michiganpharmacists.org/index2.htm.

CHAMPS Provider Notices

Pharmacies that are also enrolled as a type 87 medical supplier with the Department should review the recent MDCH Policy Bulletin MSA 08-13 for upcoming CHAMPS changes. (Bulletin is posted on the Provider tab under "Bulletins".) Enrolled medical suppliers will soon receive a letter asking them to access the CHAMPS system and revalidate their enrollment information. This applies only to medical suppliers - not pharmacy providers. If you are a medical supplier and have questions about the letter you received, you can contact the CHAMPS hotline at 1-888-643-2408 or email CHAMPS@michigan.gov.

Prescription Origin Code

This is a reminder that beginning 04/01/2008, the Michigan Department of Community Health will require pharmacies to report the type of prescription presented at the pharmacy. Claims will deny if one of the following NCPDP values for the Prescription Origin Code are not submitted: 1 = Written, 2= Telephone, 3= Electronic, 4= Facsimile. Please refer to the Department's policy bulletin MSA-08-05 for more details. Refill claims submitted 4/1/2008 or later with original Prescription Date Written prior to 4/1/2008 will not reject if the Prescription Origin Code is not populated.

Elimination of Dispense Fees for Medical Supplies

Effective March 1, 2008, the Michigan Department of Community Health will no longer reimburse a dispensing fee for a medical supply covered under the pharmacy benefit. Please refer to the policy bulletin MSA-08-04 for more details. Click here for the bulletin. For your convenience, click here to retrieve a list of products that no longer have a dispensing fee. Please note that condoms dispensed under the pharmacy benefit will continue to be reimbursed without a dispensing fee.

Brand vs. Generic Drug Co-pay Changes

Effective April 1, 2008, due to a First DataBank coding change (elimination of Generic Price Indicator), the Michigan Department of Community Health (MDCH) will employ new variables to determine if drug products will incur the generic or brand co-pay. Some drug products that were previously assigned a $3 brand co-pay will now be assigned a $1 generic co-pay and vice versa. Notification of this change was sent to beneficiaries, who may inquire about their co-pay amount(s) at your pharmacy. To assist pharmacies in responding to inquiries on co-pay changes, click on the following lists to see the drug product(s) with an increase (click here) or decrease (click here) in co-pay amount. These lists should be used for your general reference. The point of sale system will return the beneficiary's co-pay amount that is in effect at the time of claim submission. MDCH Program(s) drug coverage limitations still apply (e.g., prior authorization, quantity limits, etc.).

January 2008

Prescriber NPI Requirement (now delayed until 01/15/2008)

The Michigan Department of Community Health (MDCH) is now postponing the Prescriber NPI requirement (previously planned to occur on 10/01/2007). Now, effective 01/15/2008, MDCH will accept only the Prescriber's NPI number in the Prescriber ID field. The Prescriber’s DEA # will no longer be accepted. This requirement applies to all pharmacy claims submitted at point-of-sale to First Health. When submitting claims using the Prescriber NPI, pharmacy service providers are reminded to submit a Prescriber ID qualifier of '01' in NCPDP field number 466-EZ. Claims will deny if Prescriber's NPI number is not submitted in the Prescriber ID field. Click here to search the national NPI Registry for Prescriber NPIs.
Please refer to the following MDCH policy bulletins for more information on MDCH NPI requirements:
1) MSA 07-17 Reporting the NPI with Prescription Orders and Prescription Drug Claims,
2) MSA 07-22 contains the Pharmacy NPI Contingency Plan and
3) MSA 07-48 end of MDCH NPI Contingency Plans and,
4) MSA 07-56 Announcing Prescriber NPI requirement delayed until 01/15/2008.

November 2007

Announcement concerning 10-digit ID numbers

Pharmacy providers should continue to report a 10-digit Cardholder ID (CØ2-C2) on NCPDP claims submitted to First Health. Apparently some confusion resulted after pharmacy providers received provider bulletin MSA 07-59 from the Michigan Department of Community Health's (MDCH) regarding the new 10-digit beneficiary IDs. To clarify further, if the beneficiary's ID is only 8 digits, two leading zeros should continue to be added so that the Cardholder ID submitted is 10-digits as usual. However, for newer IDs that are actually 10 digits, no leading zeros are needed. Additional questions pertaining to this provider bulletin should be directed to MDCH Provider Inquiry via email at ProviderSupport@michigan.gov or phone toll-free 1-800-292-2550.

October 2007

Michigan Pharmacy Quality Improvement Project (PQIP)

The Michigan Department of Community Health (MDCH) is engaged in a collaborative project, entitled the Michigan Pharmacy Quality Improvement Project (PQIP) to provide information about the psychiatric medication utilization of Michigan medicaid patients. Educational alerts are sent to providers when patients are prescribed medications in ways that may vary from generally accepted evidence-based or consensus-based guidelines. This information can be linked to by selecting Committees > PQIP.

Provider associations were recently notified regarding changes to PQIP (see Association Notice). The document entitled "Child Behavioral Pharmacy Management Program Changes" (see Michigan PQIP Dosing Table), reflects highest customary doses for children and adolescents when prescribing behavioral health drugs. The PQIP workgroup composed of Prepaid Inpatient Health Plan and Michigan Medicaid Health Plan medical directors has reviewed these suggested changes and approved them for use in Michigan. This is informational only. Be aware any prescribing and treatment decisions must be based on the prescriber's clinical judgement and the patient's particular needs.

August 2007

Injectable Drugs (Update)

Due to a coding oversight, pharmacy requests for prior authorization (PA) exceptions will be granted to both home infusion and long term care pharmacies to cover injectable drugs that have been denying as a result of new point-of-sale edits effective 07/19/2007. The coding will be updated soon. Thank you for your patience.

July 2007

Injectable Drugs

Effective 07/19/2007, an enhancement of the point-of-sale edits will prevent payment for physician administered injectable drugs that were being covered incorrectly as a pharmacy benefit. This change is in accordance with Section 1.4 in the Pharmacy Chapter and Section 4.13 in the Practitioner Chapter of the Michigan Medicaid Provider Manual. To link to this policy for additional information, click on Providers >> Manuals. When following the rules of a primary insurance, there may be instances that an exception to cover as a pharmacy benefit would be appropriate. These exception requests and questions related to coordination of benefit claim submission should be directed to the First Health Technical Call Center at 877-864-9014.

MOMS Drug Coverage

Effective 07/19/2007, point-of-sale edits will reflect MOMS program drug coverage. To review the list of covered products, click here or go to Providers>>Drug Information>>MOMS Drug Coverage.

New 07/01/2007- Pharmacy Level TPL Override

Pharmacies can now submit a pharmacy level override using Prior Authorization Type Code (461-EU) = '1' to override the NCPDP 70 - NDC Not Covered w/ additional transaction message "TPL amount collected must be greater than $2.00" instead of calling or faxing the First Health call center.

June 2007

Emergency Services Only Coverage (Update)

Effective 06/27/2007, refill claims submitted with dates of service 05/01/2007 or after will deny at point of sale for beneficiaries with Emergency Services Only Medicaid. For pharmacy coverage information for this beneficiary population, review the "Emergency Services Only" chapter of the Michigan Medicaid Provider Manual by clicking on Providers>>Manuals.

Announcing a new on-line tool for Pharmacy Prior Authorizations: WEB PA

The Michigan Department of Community Health, in conjunction with First Health Services Corporation, is pleased to offer an alternative means to submit pharmacy prior authorization (PA) requests for prescription drugs. This web-based process is designed to save prescribers time by providing a real-time pharmacy prior authorization. This process will supplement the more traditional means of requesting PAs by phone or fax, which will still be available to providers. The product will be available on Monday, June 4, 2007. In order to use WebPA, provider designees will need to register to receive a log on and password for the WebPA system. Detailed information on user registration, including a web based tutorial, can be accessed by clicking here. For more information about WebPA, including a tutorial and a complete instruction manual click here. For questions or assistance with registration, call the First Health Services Web Support Call Center at 1-800-241-8726.

Looking for WebPA? Check under the Pharmacy tab above, or click here.