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BAM 402 9 of 20 MA BENEFITS BPB 2021-026 10-1-2021

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

care is early intervention to detect and treat mental or physical disease. The same components of a well-child visit and the same interval schedule are used regardless of whether the child is in a health plan or is fee-for-service. MDCH Publication (795), Michigan Free Health Check-ups for per- sons 21 and younger, explains the well-child visits. http://www.michigan.gov/mdch ENROLLED PROVIDER BILLING PROCEDURES (FEE-FOR-SERVICE) MA Enrolled providers are aware of the covered and excluded services available to MA beneficiaries. Providers must use MA billing procedures to obtain payment for services performed. Billings should be submitted within 12 months from the date of service. Twelve Month Billing Exceptions Exceptions to the 12 month billing policy can be made if the delay is caused by agency error or as a result of a court or administrative hearing decision. Agency errors are limited to: • Delayed Bridges coding, including PET code changes. • Disability Determination Service (DDS) review. • Administrative review. • Delayed eligibility determination. Exceptions cannot be granted due to provider delays in billing or failure of a recipient or provider to obtain prior authorization. Form MSA-1038, Request for Exception to the Twelve Month Billing Limitation for Medical Services, is an internal document and must be completed by local office staff to begin the exception process. The completed MSA-1038 should be sent to: 1038@michigan.gov. A family independence manager, district manager, or other office designee must be copied on the email. A copy of the hearing deci- sion is no longer required; however, the hearing registration number must be indicated on the MSA-1038.