The Michigan Department of Health and Human Services (MDHHS) released a proposed policy to update existing policy for the attending provider field on institutional hospital inpatient and outpatient claims. This update is in response to concerns raised by the MHA and hospitals regarding the claim edits implemented Jan. 1, 2022, which resulted in claim denials. The MDHHS proposes to align claim editing policy and update the definition of attending provider to mirror current federal and state laws and regulations as follows:
- The attending provider is the individual who has the primary responsibility for the treatment and care of the beneficiary.
The following providers can be reported in the attending provider field for hospital inpatient claims based on Michigan professional licensure and scope of practice statute:
- Certified Nurse Midwives.
- Oral/Maxillofacial Surgeons.
- Physicians (MD/DO).
The allowed attending provider type varies in the outpatient setting depending upon the service provided. The provider with the primary responsibility for the treatment and care of the beneficiary in the outpatient setting, including nurse practitioners and physician assistants, should be reported as the Attending Provider.
Hospitals are encouraged to review the proposed policy and submit comments to the MDHHS by Oct. 28. Members with questions should contact Vickie Kunz at the MHA.