For Billing Contact Information

Send all WISEWOMAN Program claims to:
MDHHS Claims
109 Michigan Ave
WSB - 5th Floor
Lansing, MI 48933

(866) 930-6324 - Phone
(517) 335-8752 - Fax

 

*NEW * Billing Procedure ~ View the WEBINAR here

Training schedule page

*NEW* Paper Claim Submission Guidelines

FY19 Rate Schedule
FY19 - ICD-10 Codes
FY19 Hold Codes
FY19 Revenue Codes
FY19 Place of Service Codes
FY19 Procedure Code Reference Chart
FY19 Reimbursement Tip Sheet

FY18 Rate Schedule - effective February 1, 2018
FY18 - ICD-10 Codes
FY18 Hold Codes
FY18 Revenue Codes
FY18 Place of Service Codes
FY18 Procedure Code Reference Chart
FY18 Reimbursement Tip Sheet


Billing & Reimbursement Contact Information

WISEWOMAN Program
Billing and Reimbursement

Only Current Procedural Terminology (CPT) Codes and HCPCS Codes included in the Current Fiscal Year WISEWOMAN Unit Cost Reimbursement Rate Schedule are eligible for reimbursement. The most current Rate Schedule information is available at:
FY18 Rate Schedule - effective February 1, 2018

WISEWOMAN Providers can bill for the following services for each program participant during each one‐year cycle:
• One screening office visit if WISEWOMAN visit is not integrated with BCCCNP office visit. See WISEWOMAN Non‐Integrated Office Visit Policy for more information
• One Medical Evaluation Office Visit if screening results for blood pressure, cholesterol, and/or glucose warrant a referral.
• One fasting lipoprotein panel (lipid panel) if cholesterol screening results warrant a referral. Lab results must be entered into the MBCIS WISEWOMAN module.
• One follow‐up fasting plasma glucose (FPG) if glucose screening results warrant a referral or if participant is not fasting at the WISEWOMAN office visit. Lab results must be entered into the MBCIS WISEWOMAN module. (If participant requires both a fasting lipoprotein panel and a fasting plasma glucose, both tests
should be conducted at the same time.)
• One glycated hemoglobin (HbA1c) test for a participant who is not fasting at the WISEWOMAN office visit. (Can only be billed by labs) Lab results must be entered into the MBCIS WISEWOMAN module.
• One venipuncture charge for the blood draw associated with the fasting lipoprotein panel (lipid panel) and/or the fasting plasma glucose (FPG) or Glycated Hemoglobin (HbA1c) when the test is NOT performed on the Cholestech Machine.
• Alert Value Case Management for a program participant with an Alert value for Blood Pressure or Glucose (one time per participant per annual cycle).
• Hypertension Case Management for a program participant with uncontrolled
hypertension at screening (one time per participant per annual cycle).
• When billing for Alert Value Case Management or Hypertension Case Management, the date of service should be the same as the resolution date.
• MDHHS will enter the data and authorization related to Case Management.
• Once for a New Recruit if participant is new to WISEWOMAN since 2008.
• One Follow‐Up Contact to a participant who is not ready to make changes at screening.
• Once for Medication Adherence for a participant who chooses medication adherence as her goal.
• One Initial Contact when a participant participates in her first health coaching session or lifestyle program encounter.
• One Contact Complete when a participant completes health coaching or lifestyle program.
• Health Coaching – minimum of 3 contacts
• DPP – Minimum of 9 core sessions
• TOPS – Minimum of 12 sessions
• One Outcome Evaluation Contact after participant completes health coaching or lifestyle program. Follow‐up questions and outcome evaluation contact form must be complete and entered in MBCIS.
• Once for Positive Change based on a positive participant response to questions 6 and 8 on outcome evaluation contact form.
• Once for each Diabetes Prevention Program (DPP) session attended, up to a total of 16 sessions.
• Once for every two Health Coaching contacts made after participation is complete.

 



The WISEWOMAN Vision is that every woman has the opportunity to improve
her health and well-being and that of her community.