Michigan Medicaid: How to avoid denied community health worker claims

This is a reminder to Federally Qualified Health Centers (FQHCs) billing for community health worker (CHW) services. The Michigan Department of Health & Human Services (MDHHS) requires specific information entered in claim submissions. We’re experiencing a high number of denied claims because of data omissions, errors and duplications.

Required UB-04 information

To avoid denied claims, please enter the following information on the UB-04 clinical form: 

• Modifier CG – Required for CHW services
• Attending National Provider Identifier (NPI) – The Individual Type 1 sole proprietor or independent practitioner responsible for the overall care of the UnitedHealthcare member
• Other/Rendering NPI – The CHW providing the service to the member. The CHW must be enrolled in the Community Health Automated Medicaid Processing System (CHAMPS) as of the date of the service reported on the claim. See MDHHS Provider Enrollment for instructions.
• Box 80 – Indicate the services performed, entering either a description or a 4-digit code from the table provided in the MDHHS Michigan Medicaid Policy (MMP) Bulletin, MMP 23-74

Submission reminders

• Combine claims – Do not bill CHW services on a separate claim if other medical providers rendered services on the same day. Submit only 1 claim to bill all services.
• Qualifying visits – CHW services are not considered qualifying visits. Do not bill the G04xx code with CHW services if that is the only service performed. You may bill the G04xx code only if CHW is performed along with other qualifying visit services.
• Corrected claims – When fixing issues on a previously processed claim, submit it as a corrected claim. Replicating it as a new submission will result in it being rejected as a duplicate claim. For detailed instructions on submitting a corrected claim in the UnitedHealthcare Provider Portal, visit our Claims Interactive Guide.