MEDICAID MANAGEMENT VIA ILLUMINATE EDUCATION This document provides essential information about using Illuminate Education to process and manage your Medicaid claims. BILLING AGENT INFORMATION A Billing Agent is the business authorized by MDCH to submit Medicaid HIPAA compliant transactions. To help guide you through the Billing Agent process, please review the How to Become an E-biller information on the MDCH website: http://www.michigan.gov/mdch/0,160,7-132-2945_42542_42545_42634---,00.html. Look for the Billing Agent User Guide and Billing Agent New Enrollment Quick Reference Guide. Once approved as a Billing Agent, you will use Illuminate to generate your 837 submission file. The process assumes providers are logging encounters via Illuminate. Encounters generate the data for your 837 file. For more information on logging encounters in Illuminate, you can visit http://help-ise.illuminateed.com to access the Medicaid for Service Providers manual. Below are general guidelines and processes to prepare and submit billing claims. Please Note: We are not MDCH representatives. STEP 1: Billing Agent Enrollment Application The ISD must complete the Billing Agent Enrollment Application within the CHAMPS system. You will need to have a valid SSO account. §
Visit the CHAMPS site via the MDCH website
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Click the CHAMPS logo…
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Navigate to the Billing Agent Enrollment Quick Reference Guide under Resources. This guide will walk you through the enrollment steps: Here is a direct link: http://www.michigan.gov/documents/mdch/enroll_billing_agent_229364_7.p df
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Complete the steps as described in the guide
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Once the enrollment application has been approved by MDCH, you will receive a Billing Agent ID and Data Exchange Gateway (DEG) user ID and password. Please keep this information…it will be needed when you are ready to submit claims.
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For more information, contact Automated Billing at
[email protected] or the CHAMPS hotline at 1-800-292-2550 for expert assistance
STEP 2: Email the Following to Illuminate §
Billing Agent ID
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Taxonomy ID (federal tax id)
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National Provider ID Page 1 of 4
STEP 3: Submit a Test File §
As you are applying to become a billing agent, the B2B testing process can begin. This requires submitting a test file to the State of Michigan Community business to business test site- State of Michigan Business to Business Site
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Illuminate will provide a test file of your Encounters when you are ready. You must have a minimum of 50 Encounters logged in Illuminate in order to produce a test file.
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If you would like, and with your assistance, Illuminate will complete the B2B testing for you.
STEP 4: Complete a Billing Agent Change Form The ISD must submit the 835–Electronic Remittance Advice Request for Billing Agent Change form. This form authorizes MDCH to establish an account under your new billing agent ID to receive 835 Remittance Advice files through CHAMPS. Please note: Your old Billing Agent will continue to receive these files until this step is completed. §
Go to the MDCH website: http://www.michigan.gov/mdch
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Click on Providers
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Click on Trading Partners
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Click on HIPAA Companion Guides
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Scroll to bottom of page, find Additional 835 Information
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Click on 835-Electronic Remittance Advice Request for Billing Agent Change form
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Complete and submit the form as indicated
DATA EXCHANGE GATEWAY: SENDING & RECEIVING SUBMISSION FILES The Data Exchange Gateway (DEG) is the State of Michigan’s site for secure internet file transfers. This site allows you to submit data electronically to MDCH. STEP 1: Generate 837 Submission File in Illuminate All pertinent claim data must be stored within Illuminate (i.e. encounter data entered through the Medicaid Module). The ISD is responsible for using Illuminate to generate the 837 submission file (you must be an approved Billing Agent first as described on page 1). We will train you on how to generate your initial 837 file via Go to Meeting. §
Go to the Medicaid Module in Illuminate
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Click on Billing
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Click on Create a New Batch
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Enter the desired date range and click Submit
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This will create a batch of claims
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Click on View to review the claim summary Page 2 of 4
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Once you have reviewed and verified the claims, click on Submit to generate the 837 file
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Go to the DEG website: https://dxgweb.state.mi.us/cgibin/messageway/mwi.cgi
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Enter your user name and password (provided with your billing agent info)
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Click on upload from the menu bar
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Enter Mailbox: DCHEDI and Application ID: 5475
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Browse for file to send
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Click on Upload
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Shortly after upload is complete, go to Available Messages to retrieve your 999 acknowledgment file – the file name is 5475. This file tells you whether or not the file was accepted by the state.
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If the file was accepted, the 4th line from the bottom will contain something similar to: AK9*A*4*4*. The “A” in the middle means the file was accepted. If you do not receive this, more than likely there was an error in the file.
STEP 3: Download Electronic 835 Remittance Advice (RA) After the 837 submission file has been submitted, the DEG will generate an electronic 835 file for the ISD to retrieve. The file name will be 4987 and usually posts on Thursdays. Files submitted by 3pm on Tuesday should post the following Thursday. If after Tuesday, it will take an additional week. Don’t be alarmed if the rejection file posts first (if any). §
Go to the DEG website listed above
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Enter Username and Password
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Click on Available Messages
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Click on file named 4987
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Save to your documents
IMPORTING THE ELECTRONIC 835 INTO ILLUMINATE Once you have retrieved your electronic 835 RA file you will import it back into Illuminate. §
Go to the Medicaid Module in Illuminate
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Click on Billing
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Select View for the batch that corresponds to the RA information
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Click RA Import
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Browse for file
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Click on Submit Page 3 of 4
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The RA details will be imported into Illuminate. They are broken down into 3 options: o RA Summary – includes total claim count, accepted and rejected % o RA Accepted – includes a breakdown of the accepted claims o RA Rejected – includes a breakdown of the rejected claims
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Review the RA details and make any corrections to Encounters within Illuminate if necessary (the frequency of this should be rare)
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After corrections have been made within Illuminate, another 837 file can be generated from Illuminate and submitted as described above
STUDENT MEDICAID ELIGIBILITY You must process your Medicaid Eligibility files in Illuminate. Without these, Illuminate will not be able to flag Medicaid eligible students. In order to send/retrieve Medicaid eligibility files, you must set up a user account with MPHI (Michigan Public Health Institute). MPHI offers a web-based Medicaid Eligibility service that is available to Michigan ISDs without any cost. Contact: Sonya Groesser SharePoint/Operations Administrator Michigan Public Health Institute (517) 324-6075
[email protected] STEP 1: Export a List of Students from Illuminate §
Click on the Medicaid tab
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Click Create Medicaid Eligibility Request File
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Follow the steps to export your file
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You will upload this file to MPHI
STEP 2: Import your Medicaid Eligible Students §
After you’ve submitted your eligibility file and received a response file, login to Illuminate and click the Medicaid tab
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Click Import Medicaid Eligibility Results file
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Follow the steps to import your file
STEP 3: Medicaid Flag You will see an icon to the left of a student’s name when they are flagged as Medicaid eligible. §
Click on the Medicaid tab
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Click Provider Caseload
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Select a provider
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If students on the provider’s caseload are Medicaid eligible note the icons
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