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Enrollment Requirement for Prescribers

Thursday, August 8, 2019

This message comes to you from the Michigan Department of Health and Human Services Medical Services Administration: 

The purpose of this message is to enforce federal Medicaid enrollment requirements that apply to providers who prescribe drugs to Medicaid beneficiaries. These requirements are outlined in Section 6401 of the Patient Protection and Affordable Care Act and Section 5005(b)(2) of the 21st Century Cures Act. The purpose of these requirements is to protect Medicaid beneficiaries by strengthening program integrity and care quality.

Effective October 1, 2019, providers who prescribe drugs to Medicaid beneficiaries must be actively enrolled in the Community Health Automated Medicaid Processing System (CHAMPS) – the state’s online Medicaid enrollment system. The Michigan Department of Health and Human Services (MDHHS) will prohibit payment for prescription drug claims written by a prescriber who is not enrolled in CHAMPS.

For Prescribers

Claims for drugs prescribed by a provider who is not enrolled in CHAMPS will be denied. This applies to all providers who prescribe drugs, including medical residents. In order to avoid interruptions in beneficiary drug therapy, prescribers are encouraged to enroll in CHAMPS as soon as possible. For information about the provider enrollment process and how to get started, visit www.michigan.gov/MedicaidProviders >> Provider Enrollment. Providers who have questions about the enrollment process or require assistance may contact MDHHS Provider Support at 800-292-2550.

For Pharmacies
Since July 1, 2018, Medicaid Fee-for-Service (FFS) and Medicaid Health Plans have posted the following informational edit on pharmacy claims for drugs written by a prescriber who is not enrolled in CHAMPS:

NCPDP Code 889: PRESCRIBER NOT ENROLLED IN STATE MEDICAID PROGRAM

Starting October 1, 2019, subsequent claims with this edit will be denied.

There may be certain emergency circumstances where a beneficiary must receive their prescription medication. In those instances, the pharmacy may override the edit using either of the following Submission Clarification Codes in NCPDP field 420-DK when applicable:

  • 13 – Payer-Recognized Emergency/Disaster Assistance Request
  • 55 – Prescriber Enrollment in State Medicaid Program has been validated

When the above codes are not applicable, a pharmacy or prescriber may initiate an override request by contacting the healthcare payer’s Pharmacy Help Desk. For overrides on Medicaid FFS claims, call 888-411-6343. For Medicaid Health Plan contact information, visit www.michigan.gov/MCOpharmacy.

Manual Maintenance
Retain this bulletin until the information is incorporated into the Michigan Medicaid Provider Manual.

Questions
Any questions regarding this bulletin should be directed to Provider Inquiry, Department of Health and Human Services, P.O. Box 30731, Lansing, Michigan 48909-8231, or e-mailed to ProviderSupport@michigan.gov. When you submit an e-mail, be sure to include your name, affiliation, NPI number, and phone number so you may be contacted if necessary. Providers may phone toll-free 1-800-292-2550.

 

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