Out of Network Claims must be paid at established Medicaid fees in effect on the date of service for paying participating Medicaid providers as established by Medicaid policy. If Michigan Medicaid has not established a specific rate for the covered service, the Contractor must follow Medicaid policy for the determination of the correct payment amount
In 2000, the Michigan Legislature enacted MCL 400.111i to allow Medicaid providers to file clean claims with the Commissioner against Medicaid HMOs for timely payment. Ordinarily a clean claim must be paid within 45 days after receipt of the claim by the qualified health plan. A "clean claim" must meet certain criteria set forth in the legislation and must be submitted on form FIS 278 which can be accessed through the website for DLEG's Office of Financial and Insurance Regulation (OFIR). Additional information on clean claims is available at ﾊ http://www. michigan .gov/cis/0,1607,7-154-10555_12902_35510_36782---,00.html .
Michigan Association of Health Plans Questions? www.mahp.org