Beneficiary Verification

The mihealth card does not contain eligibility information and does not guarantee eligibility. The provider can use the mihealth card to access a beneficiary's eligibility information using the CHAMPS Eligibility Inquiry and/or vendor that receives eligibility data from CHAMPS prior to rendering services.

Beneficiary Information

Beneficiary information is confidential under federal guidelines and must be used only for verifying beneficiary eligibility. If the beneficiary is eligible, the following information is available from the eligibility response:

• Beneficiary name, beneficiary ID number or MIChild Client Identification Number (CIN), gender, DOB.
• Benefit Plan ID(s) for the date of service (DOS). (Refer to the Benefit Plans subsection for additional information.)
• PET information (including the PET code), Source Provider ID (supplied through MDHHS), National Provider Identifier (NPI), provider name, telephone number, address, and the patient pay amount, if applicable.
• Medicaid Health Plan (MHP) Primary Care Physician (PCP), including the PCP name, telephone number, and NPI. (NOTE: Data is provided only if the date of service is the current date and a PCP record is on file.)
• Third-Party Liability (TPL), including the payer name, payer ID, coverage type code, group number, policy number, and policyholder ID.
• CSHCS restriction data, including qualifying diagnosis code(s) and authorized provider list if the provider submitting the inquiry is authorized for the DOS. NOTE: The 270/271 response will report up to eight (8) diagnosis codes for a single date of service. Refer to CHAMPS Eligibility Inquiry to obtain all approved diagnosis codes if more than eight (8) diagnosis codes exist for the date of service.
• Other information: Transaction date (when the data was applied to the Eligibility Subsystem), current county of residence, MDHHS case number, MDHHS worker load number, and local MDHHS office phone number.
• Pending Eligibility (Medicaid-related programs only): Providers will have the option to see if eligibility is pending.

Beneficiary eligibility may be queried using the beneficiary ID number or the Client Identification Number (CIN) (for MIChild inquiries only); or, if the ID number is not available, by using one of the following additional search options:

• Beneficiary social security number (SSN) and date of birth (DOB).
• Beneficiary name and SSN (or DOB).

Additional search options (use if needed with one of the search options above to obtain a unique member match) include:

• Gender
• Zip Code

Date of Service criteria includes the following:

• Providers can enter a single DOS or up to a 3-month DOS span. (NOTE: DOS is not required for a pending eligibility inquiry since a response is returned if a pending record exists in CHAMPS.)
• Future DOS allowed only up to the end of the current month.
• Providers are allowed to submit a DOS within 12 months of the date of inquiry.

Providers must be enrolled for the DOS in order to receive the eligibility response.

CHAMPS Eligibility Inquiry

MDHHS Provider Inquiry Helpline 1-800-292-2550 for questions/ issues related to the eligibility response, and for providers without internet access to verify eligibility.

Email: providersupport@michigan.gov

Website: Log into CHAMPS using MILogin at https://milogintp.michigan.gov

Go to the Eligibility Inquiry hyperlink located on the 'Provider Portal' page under the 'Member' section.

Benefit Plan Information: www.michigan.gov/mdhhs

 >> Resources >> Beneficiary Eligibility Verification >> Benefit Plans >>

Benefit Plan ID table

For Medicaid providers to verify eligibility for the Medicaid, CSHCS, MOMS, and MIChild programs. Refer to the Benefit Plan ID table in the Beneficiary Eligibility Chapter for a complete list of Benefit Plan IDs that are provided in the eligibility response. Providers need to utilize the Benefit Plan ID(s) indicated in the eligibility response to determine coverage for a specific DOS.