FAQ

General Information

This site is intended to provide Michigan Medicaid Eligibility information to payers/providers.

  • ABW County Health Plan
  • Community Mental Health
  • Long-Term Care Providers
  • Medicaid Health Plans
  • Out-of-State Providers
  • Pharmacy Providers
  • School-Based Healthcare
  • WIC
  • Clearinghouse/Billing Agents
  • Other Providers

Please navigate to the FAQ sections that correspond to your needs (Health Plan Benefits Users, Health Plan Benefits Domain Administrators, or X12 (270/271) and Batch Processing) and follow the listed instructions.

Eligibility information is queried in real-time from CHAMPS.

  • Login to the application.
  • Fill out a beneficiary's Medicaid ID and/or their name and date of birth.
  • Provide a coverage period.
  • Submit your request.

The Redetermination Date is returned in the eligibility response when the Provider ID of the Health Plan or LTC Facility, submitting the eligibility request, matches the Provider ID indicated in the Beneficiary’s coverage.

Benefit Plans with Redetermination Dates:

  • ABW-MC
  • CMH
  • HOSPICE
  • MA-MC
  • MICHOICE
  • NH
  • PIHP
  • SA

Health Plan Benefits Users

No. Each user is required to use their individual login and password.

On the main page of the HPB site, click the Forgot your username? link on the right side of the page.

Enter your email address and click “Send Email”. A message will be sent to the entered email address listing all the associated usernames for that email address.

On the main page of the HPB site, click the Forgot your password? link on the right side of the page.

Enter your username and click “Send Email.” A password reset link will be sent to the email on file for the registered username.

First, verify that your username is correct by using the self-service Forgot your username? link on the main page of the site.

Once you have verified your username, attempt to reset your password by generating a new reset email through the Forgot your password? link on the main page of the site.

If you are still having login issues after both steps, please contact medicaideligibility@mphi.org or submit a ticket through the Contact Us link in the footer of every page.

If you fail 5 consecutive failed login attempts your account will be locked for a 10-minute period. Every failed attempt thereafter, while the account is already locked, will increase the total lockout time.

You will need to be invited through email by a Health Plan Benefits domain administrator that is already associated with your Provider ID. If you do not already know the domain administrator(s) for your Provider ID, please contact us at medicaideligibility@mphi.org or submit a ticket through the Contact Us link in the footer of every page. You will need to provide the name of the organization as well as the Provider ID so we can provide the most up-to-date access instructions.

Note: When you receive an invitation from your domain administrator(s), you will not gain access to the Provider ID until you follow the registration steps in the email.


Health Plan Benefits Domain Administrators

If you do not have an account, navigate to the Health Plan Benefits home page and click Create an Account. You will be prompted to verify that you are the CHAMPS domain administrator for the Provider ID and complete the form with your information. Once you have received your login credentials, setup your account and log in.

If you have just setup your account, or if you already have an existing account, you will click on the “Apply to use a Provider ID” link on the home page.

You will verify that you are the CHAMPS domain administrator for the selected Provider ID, and then complete and submit the form with organizational details. After you submit the application, it will be sent for review by MPHI and MDHHS. Pending applications are processed in 7-10 business days; updates regarding the status of your application will be sent to the email associated with your user account.

If you are already a user of the Provider ID for which you need to be a domain administrator, you can also be promoted to a domain administrator by a domain administrator already registered with your Provider ID.

Click on the “Update User Profile and Provider IDs” link on the home page. Scroll to the bottom of the User Profile page, to the table titled “Approved Provider IDs,” and click “View” for the Provider ID to which you wish to be a domain administrator. In the “Domain Administrators” table in the middle of the Provider ID Management page, the contact information for the registered domain administrators will be listed; you can use this information to contact the domain administrators and request an invitation.

Once you log in, on your home page there will be a link titled “Update User Profile and Provider IDs”. Click that link, and you will be taken to your account page.

Scroll to the bottom of the User Profile page to the table titled “Approved Provider IDs,” and click “View” for the Provider ID to which you wish to manage users.

In the “Manage Users Section” table at the bottom of the Provider ID Management page, you can click “View” on a user row to view user information and promote a user to a domain administrator, “Remove” to revoke user access to the Provider ID, or the “Add User” button to open and submit the form to add new users.

Note: Users added to your Provider ID must follow the steps in the invitation email to register their account. Until the user has done so, they will remain listed in the “Pending Users Section” of the Provider ID Management page.

Once you log in, on your home page there will be a link titled “Update User Profile and Provider IDs”. Click that link, and you will be taken to your account page.

Scroll to the bottom of the User Profile page, to the table titled “Approved Provider IDs,” and click “View” for the Provider ID to which you wish to make changes.

In the “Provider ID Details” table at the top of the Provider ID Management page, click the “Create an Edit Application” button to generate and complete the application form. You will need to verify that you are still a CHAMPS domain administrator for the Provider ID.

After you make any necessary updates and click “Submit Application”, the application will be reviewed by MPHI and MDHHS. Pending applications are processed in 7-10 business days; updates regarding the status of your application will be sent to the email associated with your user account.


X12 (270/271) and Batch Processing

MPHI is now able to accept Real-Time/Batch HIPAA 270/271 transactions from all Providers, Billing Agents, and Clearinghouses registered with CHAMPS. These services are provided on behalf of MDHHS and are available free-of-charge.

The following data is provided directly from the CHAMPS Eligibility and Enrollment Subsystem.

  • Benefit Plan ID and additional provider information returned in the 2120C loop, if applicable.
  • Beneficiary Address data.
  • Medicaid Health Plan (MHP) Primary Care Physician (PCP), including the PCP name, telephone number, and National Provider Identifier (NPI). Note: Data provided only if the date of service is the current date.
  • Third Party Liability (TPL), including the Payer Name, Payer ID, Coverage Type Code, Group Number, and Policy Number.
  • CSHCS restriction data, including qualifying diagnosis code(s) and authorized provider data if the provider submitting the inquiry is authorized for the date of service.
  • Pending Eligibility data (Medicaid-related programs only).
  • Other information, including Current County of residence, DHS Case Number, DHS County Office, and DHS Local Office number.
  • Support for DSH inquiries beyond one year of prior coverage.

Note: DSH related eligibility inquiries are only available to providers enrolled under the FAO enrollment type that have completed the DSH question under the "Manage Provider Checklist" (in the CHAMPS-PE subsystem) and have received approval from MDHHS.

  1. Download the MPHI companion guide and determine which services your organization is interested in using.
    • Real-Time Web-Service (RESTful Web-Service)
    • Batch Web-Service (SOAP Web-Service)
  2. Enroll as a Provider or Billing Agent in CHAMPS.
    • www.michigan.gov/providers > Providers > Champs
    • Note: Clearinghouse vendors need to enroll as a Billing Agent and be associated with the Providers they represent to be able to submit HIPAA 270/271 transactions on their behalf. For information on how to associate MPHI as a Billing Agent, please click here.
  3. Complete MPHI’s online registration form.
  4. Allow 5-10 business days for MDHHS to review your application. MPHI will contact you with login/password and instructions on how to use our HIPAA 270/271 web-services once your application has been approved.

MDHHS 270 271 Companion Guide

This companion guide provides specific details on how Michigan Medicaid coverage information is handled in a 270/271 transaction.

MPHI Companion Guide

This companion guide details how to submit transactions to MPHI's Medicaid Clearinghouse. Details for both the Real-Time and Batch Web-Services have been consolidated into the same document.

The MPHI Eligibility systems go down for maintenance during the CHAMPS maintenance windows.

  • CHAMPS has a monthly maintenance window that occurs on the second Saturday of the month from 6PM on Saturday to 9AM on Sunday.
  • CHAMPS has a weekly maintenance window that occurs every Sunday from 8AM to 10AM.
Note: For more information on CHAMPS outages, please see their companion guide (above) or check on Biller "B" Aware at www.michigan.gov/mdhhs > Doing Business with MDHHS > Health Care Providers > Providers > Medicaid > Medicaid Alerts > Biller "B" Aware.


Contact Information

In addition to this FAQ page, you can also find further information about Health Plan Benefits website processes in the User Guide. If your question has not been addressed, or if you need further assistance, you can contact the Medicaid Eligibility Team through the information below or by submitting a ticket through the Contact Us link in the footer of every page.

Provider Support

(800) 292-2550

Contact for assistance with CHAMPS, billing, and claims.

Medicaid Eligibility Support & Outages

medicaideligibility@mphi.org
(517) 324-6095

Contact for assistance with the MI Health Plan Benefits website or if you are unsure where to direct your inquiry.