Claims

Claims from all providers (contracted and non contracted) are paid according to the Michigan Medicaid Fee-For-Service Fee Schedules in effect on the date of service or the billed charges, whichever amount is less, unless other arrangements have been made.

All providers must submit claims using the following forms:

  • Professional Claims – CMS 1500
  • Facility Claims – UB-04

All claims must include the provider’s National Provider Identifier.

Sample copies of these forms appear in the Claims section of the Provider Manual.

The Upper Peninsula Health Plan encourages all providers to submit claims electronically.

To learn the status of a claim, call the Upper Peninsula Health Plan Claims Department at 1-906-225-7746 or 1-800-835-2556.

Electronic Claims

Submit electronic claims using National Electronic Insurance Code 38337.

If you have questions about submitting electronic claims, call the Claims Department at 1-906-225-7746 or 1-800-835-2556.

Paper Claims

Mail all paper claims to:

Upper Peninsula Health Plan
853 West Washington Street
Marquette, MI 49855

The Upper Peninsula Health Plan does not accept handwritten claim forms.

DRG Groupers

The Upper Peninsula Health Plan pays inpatient hospital stays based on MSA approved DRG Groupers.  To view this information, click here.

In the event that a provider disagrees with a claim payment denial, an appeal may be filed.  To learn more, click on the policy below.

Claims Appeals Policy
(Policy and Procedure/Effective June 2016.)

 


Page Last Updated: 09/26/2018