Claim Payment Initiatives

McLaren Health Plan follows the claims reimbursement policies and procedures set forth by MDHHS and CMS. Reimbursement for Medicaid and Medicare is based on the prevailing State of Michigan Medicaid or Medicare fee schedule.

MHP accepts both paper (CMS 1500 and UB-04 claim forms) and electronic claims. All claims must be submitted and received by MHP no later than one year from the date of service to be eligible for reimbursement. Claims received that exceed this filing limit may be denied.

To facilitate transparency and improved communication regarding various claim payment initiatives, McLaren Health Plan has developed the following content to share current status updates on these projects. Using the information below, you can track progress and easily access key details.

We appreciate your cooperation and patience as we work to resolve claims efficiently.

DATE TOPIC  ANNOUNCEMENT DESCRIPTION LINE OF BUSINESS IMPACTED SPECIALTIES STATUS ESTIMATED COMPLETION
9/15/2025 Clerical Overpayment Recoupment Telemedicine Modifier 93 and 95 McLaren found payments associated to service codes not on the published telemedicine fee schedules. Medicaid Multiple In Process 10/31/2025
9/19/2025 Clerical Overpayment Recoupment Bilateral Modifier Following a post-adjudication audit, McLaren Health Plan identified claims that were inappropriately reimbursed. Medicaid Multiple In Process 11/15/2025
9/19/2025 Clerical Overpayment Recoupment Global Surgery Following a post-adjudication audit, McLaren Health Plan identified claims that were inappropriately reimbursed. Medicaid Multiple In Process 11/15/2025
9/19/2025 Clerical Overpayment Recoupment Medically Unlikely Edits Following a post-adjudication audit, McLaren Health Plan identified claims that were inappropriately reimbursed. Medicaid, Commercial, Medicare, and Health Advantage Multiple In Process 11/15/2025
9/19/2025 Clerical Overpayment Recoupment Procedure to Procedure (PTP) Following a post-adjudication audit, McLaren Health Plan identified claims that were inappropriately reimbursed. Medicaid Multiple In Process 11/15/2025
9/19/2025 Clerical Overpayment Recoupment Status B Bundled Payment Following a post-adjudication audit, McLaren Health Plan identified claims that were inappropriately reimbursed. Medicaid Multiple In Process 11/15/2025
10/15/2025 Clerical Overpayment Recoupment 72 Hour Following a post-adjudication audit, McLaren Health Plan identified claims that were inappropriately reimbursed. Medicaid, Commercial, Health Advantage, and Medicare Multiple In Process 12/1/2025
10/15/2025 Clerical Overpayment Recoupment New vs Established Following a post-adjudication audit, McLaren Health Plan identified claims that were inappropriately reimbursed. Medicaid Multiple In Process 12/1/2025
10/15/2025 Clerical Overpayment Recoupment Procedure to Procedure Following a post-adjudication audit, McLaren Health Plan identified claims that were inappropriately reimbursed. Commercial, Health Advantage, Medicare Multiple In Process 12/1/2025