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Submitting a Claim to HealthPlus of Michigan

Effective 1/1/2015, all participating providers must submit their claims electronically.  All paper claim submissions from participating providers will be denied.

HealthPlus also strongly encourages all non-participating providers to submit claims electronically.

Advantages of electronic billing include:

  • Faster claims processing & claim payment
  • Reduced paperwork
  • Greater control over claims accounts
  • Quicker resolution of discrepancies

Instructions to submit claims electronically.

Non-participating provider instructions to submit claims in hard copy format.

Attachments for Electronic Claims 

If an attachment needs to be included with an electronic claim, please fax to: HealthPlus of Michigan Claims Department, Fax Number (810) 230-2289 at the time you submit the claim electronically. 

Please include a subject of “Electronic Claim Attachment” along with the HealthPlus of Michigan Member ID number. The attachment will be stored with the member record in our system and referenced when the electronic claim is processed.

If you need to submit an electronic attachment for a claim that was submitted previously, please see the instructions under Claims Adjustments.   

Attachments that will be accepted via fax for electronic claims include:

  • Invoices needed for pricing
  • Documentation for NOC codes
  • Sterilization/Hysterectomy Consent forms

Please note: COB vouchers will not be accepted via fax. Providers should be including all COB voucher information with their electronic file.

Coding of Procedures and Diagnoses for Billing 

All claims with dates of service 09/30/2015 and prior should be using:

  • ICD-9 Indicators
  • CPT-4 and/or HCPCS coding schedules (including modifiers) to designate procedures
  • ICD-9-CM for diagnoses

All claims with dates of service 10/01/2015 and later should be using:

  • ICD-10 Indicators
  • ICD-10-PCS (including modifiers) to designate procedures in hospital inpatient healthcare settings
  • CPT-4 and/or HCPCS coding schedules (including modifiers) to designate procedures
  • ICD-10-CM for diagnoses

If there is no designated CPT code available, HealthPlus accepts HCPCS (Health Care Financing Administration Common Procedure Coding System ) codes denoted by a single alpha letter (e.g., A9270). Ancillary providers (vision providers, ambulance services, home health, or skilled nursing agencies) should refer to the specific coding instructions in the provider's contract with HealthPlus.

Electronic Funds Transfer

HealthPlus can deposit your claims reimbursement directly into your bank account on a weekly basis if you replace your printed Explanation of Payment (EOP) with an ANSI 835 file. 

Complete and submit the HealthPlus EFT enrollment form, to begin receiving electronic payments.

The HealthPlus Reports portal provides streamlined, electronic report management and distribution by allowing 24-hour access to your reports (including EOPs) in a secure web environment. You can view, download or print the reports that you need, from an easy-to-use menu.

If you currently bill claims electronically and have agreed to replace your printed EOP with the electronic version, you must complete and submit a HealthPlus Web Access Request Form   in addition to a voided check, for the account to which to are to be transferred.

To set up electronic billing, please contact the HealthPlus EDI Coordinator at (800) 345-9956, ext. 2084.

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