MI Health Plan Benefits (2024)

What is the purpose of this website?

This site is intended to provide Michigan Medicaid Eligibility information to payers/providers, such as hospitals, doctor’s offices, and pharmacies.

This site is not for citizen use. Please see the response for Citizen Assistance below for more information.

Who is this service provided to?

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

How do I sign up for this service?

Where else can I get Medicaid Eligibility information?

Please reference the State of Michigan website.

What are the Benefit Plans?

Please reference the Benefit Plans page.

Where can I find information about the healthcare programs administered by MDCH?

Please reference the Michigan Medicaid Provider Manual.

How do I update TPL Coverage Information?

Please reference How to Update TPL Information.

How often is eligibility information updated?

What if the eligibility information is incorrect?

The information is queried in real-time from CHAMPS, if the patient’s Eligibility information is incorrect, please contact CHAMPS Provider Support for assistance.

CHAMPS Provider Support
(800) 292-2550
Contact for assistance with CHAMPS, billing, and claims.

How do I submit an Eligibility Request?

• Login to the site
• On the Home Menu - Select the method for searching in the section “Check for Patient Eligibility”
• Fill out a beneficiary's Medicaid ID and/or their name and date of birth.
• Provide a coverage period.
• Submit your request.

When is the Redetermination Date returned?

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

Who should I contact with questions or comments about this site?

How do I find information about my personal Medicaid benefits?

Unfortunately, the MI Health Plan Benefits site cannot assist with citizen/patient inquiries.

This website is for providers such as hospitals, doctors offices, pharmacies, etc., to look up patient information, this site is not for citizen use.

For assistance, you can try the resources below:

• Your local MDHHS office, look up here: https://www.michigan.gov/mdhhs/0,5885,7-339-73970_5461---,00.html
• Michigan Enrolls site: https://healthcare4mi.com/
• Beneficiary Help Line at 1-800-642-3195; they should also be able to provide further information on your inquiry.

What are the different roles for accounts?

There are 2 types of roles a Health Plan Benefits account can have: User or Domain Administrator.

• User role - Allows the user to perform Individual and Multiple Eligibility lookups, they are not responsible for managing other users.
• Domain Administrator role - Users with the added Domain Administrator role manage the users associated with a Provider ID.

Can I share a login account with other people within my organization?

How do I retrieve my username?

On the main login page of the Health Plan Benefits site, select the Forgot your username? link on the right side of the page.

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

Please check your spam folder in case it was directed there. If you do not receive an email with your username and it is not in your spam folder, contact Health Plan Benefits Support with the Contact Us form.

How do I reset my password?

On the main login page of the Health Plan Benefits site, select the Forgot your password? link on the right side of the page.

Enter your username and select “Send Email.” A password reset link will be sent to the email on file for the registered username. Please check your spam folder in case it was directed there.

If you do not receive an email with your username and it is not in your spam folder, contact Health Plan Benefits Support with the Contact Us form.

I am receiving an “Invalid login attempt” message. What should I do?

First, double check that you are using the correct password; do not autofill the password, caps lock is not on etc.

Then refresh your browser session, clear your browser history and cache, or even fully restart your computer.

Then 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 trying these steps, please contact Health Plan Benefits Support with the Contact Us form.

My account is locked. What is the lockout policy?

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 must wait the length of time displayed on the screen when you lock yourself out.

While you wait, refresh your browser session, clear your browser history and cache, or even fully restart your computer.

If you are still having login issues after trying these steps, please contact Health Plan Benefits Support with the Contact Us form.

I am having issues with 2 Factor Authentication. What should I do?

All Health Plan Benefits site accounts must complete authentication during the login process, once per day.

• Email - this will be the default selection if a cell phone number is not provided in the account profile.
• Text - this is option is only available if a cell phone number is provided in the account profile.

Select the method you wish to receive the code, by selecting either Text Message or Email.

The authentication code will arrive within a few minutes, you have 5 minutes to enter that code until it expires.

Some tips to help you login successfully:

• Check your spam folder in case the authentication code was sent there.
• You have 5 minutes to enter the code before it expires.
• Try logging in again, sometimes the first attempt doesn’t work as it should.
• If you select “Text Message” or “Email” more than once, you will receive multiple authentication texts or emails. The newest code will invalidate the previous codes sent.

Then refresh your browser session, clear your browser history and cache, or even fully restart your computer. Then try to authenticate with a new code by logging in again.

If you are still having login issues after trying these steps, please contact Health Plan Benefits Support with the Contact Us form.

How do I get access to another Provider ID as a user?

You will need to be invited through email by a Health Plan Benefits domain administrator that is already associated with that Provider ID.

If you do not already know the domain administrator(s) for that Provider ID, please contact Health Plan Benefits Support by submitting 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.

At that time, you can create a new account or use your existing account to add this new Provider ID.

I have multiple accounts, how can I merge them into 1 account?

Why doesn't my CHAMPS username work on this site?

How do I get access to a Provider ID as a user?

You will need to be invited through email by a Health Plan Benefits domain administrator that is already associated with that Provider ID.

If you do not already know the domain administrator(s) for that Provider ID, please contact Health Plan Benefits Support by submitting a ticket through the Contact Us link in the footer of every page.

• You will need to provide the Provider ID number (CHAMPS ID or National Provider ID) of the Organization as well as the name of the Organization so we can provide the most up-to-date instructions.

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

At that time, you can create a new account or use your existing account to add this new Provider ID.

I have an account; how do I find the Domain Administrator for the Provider ID?

Select on the “Update Provider IDs” link on the home page. Scroll to the middle of the Update Provider ID page, to the table titled “Approved Provider IDs,” and select “View” to see details for the Provider ID.

In the “Domain Administrators” table in the middle of the Provider ID Management page, you can view the contact information for the registered domain administrators.

If you need help identifying the Domain Administrators, please contact Health Plan Benefits Support with the Contact Us form.

How do I get access to a Provider ID as a domain administrator?

If you do not have an account, navigate to the Health Plan Benefits login page, and select “Apply for an Account”.

You will confirm that you are the CHAMPS domain administrator for the Provider ID, and you will complete the form with your personal information and the Provider ID information as it appears in CHAMPS.

Once your application has been approved, you will receive an email with your login credentials, so you can setup your account and log in.

If you already have an existing account, you will select on the “Apply to be a Domain Administrator” 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, your role can be updated to a domain administrator by a domain administrator already registered with your Provider ID.

How do I manage my users as a domain administrator?

Once you log in, on your home page select “Update Provider IDs”. The next page is the Update Provider ID.

Scroll to the bottom of the User Profile page to the table titled “Approved Provider IDs,” and select “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 select “View” on a user row to view user information and promote a user to a domain administrator, “Remove” to remove 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.

How do I manage my Provider ID as a domain administrator?

Once you log in, on your home page there will be a link titled “Update User Profile and Provider IDs”. Select 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 select “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, select 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 for the Organization and select “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.

What is X12 (270/271) and Batch Processing?

What data is provided?

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.

How do I enroll to submit 270/271 transactions?

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, pleaseclick here.
3. Complete MPHI’s online registration form.
   • Apply for Access
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.

Where can I get more information?

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.

When will the CHAMPS maintenance windows impact MPHI Eligibility services?

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 based on your role in theUser Guide or Domain Administrator Guide.

If your question has not been addressed, or if you need further assistance, you can contact the appropriate Medicaid Eligibility Support teams through the information below.

CHAMPS Provider Support for questions about the CHAMPS site

(800) 292-2550
Contact for assistance with CHAMPS, billing, and claims.

Health Plan Benefits Support - 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.