Requirements for Establishing mdlogix as a Trading Partner - MI

Required Information for Configuration

In order to set up in-house billing, a few key pieces of information are needed! Please supply the following:

• An NPI for your top-level organization (ISD, LEA, etc.). Should be a 10 digit identifier.
  (Format: 1234567890)

• An EIN for your top-level organization. Should be a 9 digit identifier.
  (Format: XX-XXXXXXX)

• The nine-digit zipcode for every location you wish to bill for services performed (For instance, if a district has two high schools, two middle schools, and four elementary schools, you’d be supplying a total of 8 zipcodes). Please note that the five digit zipcode is not sufficient.
  (Format: XXXXX-XXXX)

Please complete the form (linked here), with all required information, and then share with bhworks.

If the above pieces of information are incorrect/missing, it will lead to a rejection of all relevant claims.

Documentation Checklist

• Consent: all services require consent to be billed, even screening or crisis services (consent should not be a barrier to performing a crisis service, but it is a barrier to billing the service).
  
  

• POC: most services require a POC to be billed. For services where a POC is required, the POC must be signed by the date of the service for the service to pass our validations.

  • You have 30 days before the POC is signed where services can be billed
    
    

• Service and Diagnosis Codes: all services must have a valid CPT service code and ICD-10 diagnosis code (“Reason to Treat”, either Z-code or F-code) in order to be billed. There are no exceptions.
  
  

• Physician Order: most nursing services require a Physician Order to be billed. For services where a Physician Order is required, it must be signed by the date of service for the service to pass our validations. The order must also list the billing code for the service being performed as one of the “ordered services”.

  • Please note that for some nursing services to be billed, the Physician Order must include the NPI of the provider giving the order.
    
    

Adding mdlogix as a Trading Partner

• Follow the instructions on the following presentation: Associate a Billing Agent and Authorize the 835 - Michigan. Make sure to go through each slide, paying special attention to the following:
  
• Please make sure to have all of the Electronic Batch, Billing Agent, Paper Claims, and Direct Date Entry (DDE) boxes checked, as instructed on page 10/11.
• On page 15, our Billing Agent ID field is DCH0167
• Please make sure to authorize us to receive the 835 file (page 17)