Back to dashboard
MedicaidAdministrativeHigh impact

Michigan Medicaid: How to avoid denied community health worker claims

UnitedHealthcare·MI · Family Medicine, Internal Medicine, General Practice +1 more·State news
Effective date
Not stated
We identified it
Jun 13, 2026
Days to comply
—

Summary

Michigan Medicaid is experiencing high denial rates for community health worker (CHW) claims at FQHCs due to missing required information. Specific data must be entered on UB-04 forms including modifier CG, attending NPI, rendering CHW NPI, and service descriptions in Box 80.

Action Required

Action needed
Immediately: Billing team must update UB-04 claim submission process for CHW services to include: 1) Modifier CG for all CHW services, 2) Attending NPI (Individual Type 1 practitioner), 3) Other/Rendering NPI for the CHW (must be enrolled in CHAMPS), 4) Box 80 service descriptions per MDHHS MMP Bulletin MMP 23-74. Combine CHW services with other same-day services on single claims. Do not bill G04xx codes if CHW is the only service. Submit corrected claims (not duplicates) to fix previous denials.

Related policy hubs