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BAM 402 10 of 20 MA BENEFITS BPB 2021-026 10-1-2021

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

MDHHS will notify the specialist within 30 days of the decision. If approved MSA will notify providers to bill Medicaid as usual but to enter in the comments section of the claim, “MSA 1038 approval on file”. MEDICAL SERVICES PROVIDER POLICIES MA Local office staff is not expected to be the beneficiary's primary source of information for covered services. The providers of medical services are best equipped to determine medical needs and whether those services are covered by MA as specified in the MA provider manuals. Some basic guidelines: • The provider is required to bill all other insurances prior to billing MA. • Providers must be appropriately licensed and/or certified before entering into an agreement with MDHHS to participate in the MA program. • Enrolled providers receive direct payment for services rendered but must agree to provide services according to the policies published in the MA provider manuals. • Certain medical/dental services require the provider to obtain prior approval from MDHHS; see the MedicaidProviderManual.pdf (state.mi.us) for co-pay information. • The provider is required to accept payments received from MA as payment in full, except for patient-pay amounts authorized by MDHHS and co-payments. • The provider may seek payment from a beneficiary for services not covered if the beneficiary elects to receive the services with the prior knowledge that such services are not covered. • Institutional and nursing home providers holding a beneficiary’s funds in trust are accountable to the beneficiary and may not require the deposit of such funds with the facility. The management of such funds is subject to review by MDHHS.