Health Plan Benefits Application Real-Time and Batch Transactions Users
Organizations requesting access to the Health Plan Benefits website must have an active Trading Partner Agreement with Michigan Medicaid.
Organizations requesting access must be classified as one of the following: ABW County Health Plan, Medicaid Health Plan, Community Mental Health, School-Based Healthcare, Long-Term Care Provider, Pharmacy, or "Out-of-State" Provider.
Eligibility coverage obtained from the Health Plan Benefits website must be kept confidential per HIPAA Privacy regulations.
Users requesting access (or that access is being requested on behalf of) are employed and authorized to view Medicaid Eligibility information by the organization identified in the application.
User accounts are for individual use and will not be shared for use by any other person(s) within or outside of the organization that the user is employed.
X12 270/271 Real-Time and Batch Transactions Trading Partner Organizations
Check eligibility for a patient currently being treated or serviced by you, or has contacted you about a treatment or service, or for whom you have received a referral from a provider that has treated or serviced that patient.
- Determine whether a beneficiary is enrolled in or has pending coverage in a program administered by Michigan Medicaid.
- Determine whether a beneficiary has Third Party Liability coverage in addition to Michigan Medicaid coverage
- Determine beneficiary payment responsibilities.
- Determine proper billing.
- Organization requesting access must be an active Michigan Medicaid Provider registered in CHAMPS or a Billing Agent registered in CHAMPS associated with one (or more) active Providers.
- Organization will ensure that proper security measures are in place to associate each 270 with the individual that submitted the inquiry.
- Organization is fully accountable for all transactions submitted and will cooperate with MPHI or its agents in the event that there is a security concern with respect to the any 270 submitted by the organization to MPHI.
- Organization will promptly contact MPHI in the event that the identity or contact information of the Domain Administrator changes, or if any of the assurances are no-longer met.
- Organization will immediately cease transmission of 270 transactions to MPHI at such time any of the assurances herein provided are no longer met.
- Organization will not disclose, lend, or otherwise transfer authentication information for this service to someone else.
- Organization will not browse or use this service for unauthorized or illegal purposes.
- Organization will comply with any and all requirements of their Trading Partner agreement with Michigan Medicaid.
- Organization will comply with any and all HIPAA privacy regulations.
- Organization must promptly notify MPHI if account is no longer in compliance or needs deactivation.
All Clearinghouse/Billing Agent Organizations
- Clearinghouse will release eligibility data only to active Michigan Medicaid Providers (or their Billing Agents) for their specific purposes. Clearinghouse will not disclose information to anyone other than the Provider submitting the inquiry.
- Clearinghouse will only submit inquiries on behalf of Providers they are associated with as a Billing Agent in CHAMPS.
- Clearinghouse will be able to associate each 270 with the Provider that submitted the inquiry.
- Clearinghouse will ensure that Providers utilizing the Clearinghouse have proper security measures in place to associate each 270 submitted with the individual that submitted the inquiry.
- Clearinghouse will ensure that any 270 inquiry prepared by a Provider utilizing their service is compliant with any HIPAA and/or Companion Guide rules for this transaction.
All Provider Organizations
- Each eligibility inquiry will be limited to requests for eligibility data with respect to a patient currently being treated or serviced by you, or has contacted you about a treatment or service, or for whom you have received a referral from a provider that has treated or serviced that patient.
- Provider will ensure that proper security measures in place to associate each 270 submitted with the individual that submitted the inquiry.
- Provider will only submit 270 transactions if they are a valid non-terminated Michigan Medicaid Provider.