Michigan Medicaid Issues Guidance to Reduce Denials for Community Health Worker Claims

Mar 26, 2026

2 minutes

Michigan Medicaid Issues Guidance to Reduce Denials for Community Health Worker Claims

The Michigan Department of Health & Human Services (MDHHS) has issued an important reminder to Federally Qualified Health Centers (FQHCs) regarding billing requirements for Community Health Worker (CHW) services. The advisory comes amid a noticeable rise in claim denials attributed to incomplete, inaccurate, or duplicate submissions.

Key Requirements for UB-04 Claim Submissions

To ensure successful reimbursement and avoid denials, providers must include the following mandatory details on the UB-04 claim form:

Modifier CG: This modifier is required for all CHW services billed.
Attending NPI: Must reflect the Individual Type 1 provider (sole proprietor or independent practitioner) responsible for the patient’s overall care under UnitedHealthcare plans.
Rendering/Other NPI: Must identify the CHW delivering the service. The CHW must be actively enrolled in the Community Health Automated Medicaid Processing System (CHAMPS) on the date of service. Check provider enrollment for more info.
Box 80 (Remarks Section): Providers must clearly document the services performed, either through a descriptive entry or by using a valid 4-digit code as outlined in MDHHS Michigan Medicaid Policy Bulletin MMP 23-74.

Critical Billing Reminders

MDHHS also highlighted several key submission practices to prevent avoidable denials:

Single Claim Submission: When CHW services are provided alongside other medical services on the same day, providers must submit a single, combined claim. Separate billing for CHW services in such cases is not permitted.
Qualifying Visit Criteria: CHW services alone do not qualify as a billable visit. The G04xx code should only be used when CHW services are delivered in conjunction with other qualifying medical services.
Corrected Claims Protocol: If revisions are needed for a previously processed claim, providers must submit it as a corrected claim. Resubmitting it as a new claim will result in automatic rejection due to duplication. Visit Claims Interactive Guide

Provider Support

Providers seeking assistance can access 24/7 support through the UnitedHealthcare Provider Portal, which offers chat-based help and additional claims submission guidance.

Services

Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

Eligibility Verification

Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

Revenue Cycle Management

RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

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