Download File - FOSTERING FORWARD MICHIGAN

ADOPTION MEDICAL SUBSIDY BILLING PROCEDURES FOR
ORTHODONTICS
For orthodontic conditions certified with effective dates beginning August 1, 2002,
total lifetime payments through the Adoption Medical Subsidy Program will
be limited to $3,500.00. This includes any and all services related to
orthodontic treatment.
Payment/reimbursement for a medical service can be made only when:
1. The child has been certified by Adoption Medical Subsidy Program and the
services are provided on or after the effective date of certification.
2. Claims for surgical procedures related to orthodontia (ex. extractions), must
first be submitted to Medicaid if Medicaid covers the child or to the parent’s
major medical provider if the parent’s private insurance covers the child.
3. Documentation has been provided to the Adoption Subsidy Office that the bill
has been submitted to the parent’s private health insurer or other funding
sources which are available to the child. Rejections and/or payment notices
from these other funding sources must be attached to the bill that is mailed to
this office.
4. The bill is submitted within four months of the date of service; OR
5. If the child is covered by the parent’s private health insurance, the bill must be
submitted within 4 months of the parent or provider receiving documentation
of partial payment or rejection of payment by the insurance company.
6. The provider is registered on MAIN, the State of Michigan’s payment system.
To register on MAIN vendors may go to www.cpexpress.state.mi.us or
telephone (517) 373-4111 to obtain a registration packet by mail.
7. Missed appointments are not covered.
Whenever possible, the family should have the service provider bill the Adoption
Subsidy Program. Bills should be mailed to:
Department of Human Services
Adoption Medical Subsidy Payments Ste. 412
P.O. Box 30037
Lansing, Michigan 48909
A faxed bill cannot be accepted.
The following information must be included on the original billing statement:
1. Parent’s name, child’s legal name and date of birth.
2. Name of the service being provided and the date of service.
3. Provider’s Federal ID Number or Social Security number.
07/2006 adoptorthobillprocedures