MedStats Billing delivers end-to-end revenue cycle management built for Michigan practices. We claim the 12% statutory interest Michigan owes on clean claims left unpaid past 45 days, price auto injury care correctly under the no-fault fee schedule in MCL 500.3157, and bill all nine Comprehensive Health Care Program plans across every Prosperity Region in the Great Lakes State.
No state has changed the economics of treating injury patients as sharply as Michigan. Public Act 21 of 2019 replaced unlimited personal injury protection with elected coverage levels and imposed a Medicare-based cap on what an auto insurer will pay. The result is that two patients with identical injuries can carry entirely different reimbursement ceilings depending on the date of the crash and the coverage their policy elected. Getting that determination right before the first claim goes out is the difference between full payment and a write-off.
Michigan Billing Specializations:
Michigan Prompt Pay (MCL 500.2006) — A clean claim must be paid within 45 days of receipt, and a clean claim not paid within 45 days bears simple interest at 12% per annum. The plan must state any defect in writing within 30 days of receipt. We calendar both dates and claim the interest.
No-Fault Fee Schedule (MCL 500.3157) — Reimbursement for auto injury care is capped at 190% of the Medicare amount payable since July 1, 2023, and at 52.5% of the provider’s 1 January 2019 charge where Medicare lists no amount payable. The cap is the lesser of the two, so both figures must be calculated.
The Andary Date Test — Under the Michigan Supreme Court’s decision in Andary v. USAA the fee schedule does not apply to insured victims whose crash occurred before 11 June 2019. Date of accident, not date of service, decides whether the cap applies at all.
PIP Election Verification — Michigan drivers now choose between $50,000 for Medicaid enrollees, $250,000, $500,000, unlimited coverage, or a Medicare opt-out with no PIP medical coverage at all. We confirm the election and remaining balance before treatment continues.
Comprehensive Health Care Program — Nine Medicaid health plans under contracts effective 1 October 2024 and running to 30 September 2029, awarded by Prosperity Region: Aetna Better Health, Blue Cross Complete, HAP CareSource, McLaren Health Plan, Meridian Health Plan, Molina Healthcare, Priority Health Choice, UnitedHealthcare Community Plan and Upper Peninsula Health Plan.
Major Michigan Payers — Blue Cross Blue Shield of Michigan, Priority Health, HAP, McLaren, Molina and Meridian denial workflows.
Built to bring clarity, control and consistency to your Michigan practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for Michigan providers — from CHAMPS enrollment and Medicaid health plan credentialing, through no-fault and commercial claim submission, to prompt-pay interest recovery and denial resolution.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
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Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
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Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
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Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
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A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
Explore serviceLocal SEO, Google Business Profile optimization, and reputation management built for medical practices — helping the patients already searching for your specialty find you first.
Explore serviceMichigan practices lose more revenue to the no-fault rules than to anything else, and almost none of them claim the interest the state already owes them. These are the four we eliminate:
Under Andary v. USAA the no-fault fee schedule does not apply to insured victims injured before 11 June 2019. Practices that apply the 190% cap to every auto claim voluntarily discount care that is not subject to any cap, and the money is never recovered.
A clean claim not paid within 45 days bears simple interest at 12% per annum under MCL 500.2006. Most practices treat a late payment as simply late. Across a year of aged claims the unclaimed interest alone is material.
A patient may carry unlimited coverage, $500,000, $250,000, $50,000 as a Medicaid enrollee, or have opted out of PIP medical entirely. A $50,000 limit is exhausted quickly by a serious injury, and care delivered after exhaustion has no no-fault payer at all.
The no-fault cap is the lesser of the applicable Medicare percentage and the average amount the provider charged for that treatment as of 1 January 2019. Practices that calculate only the Medicare figure bill above the ceiling and see the balance denied.
A clean claim must be paid within 45 days after receipt by the health plan, and a clean claim not paid within 45 days bears simple interest at 12% per annum. The plan must notify the provider of any defect in writing within 30 days, and the 45-day period is tolled from that notice until the provider responds.
Michigan gives Medicaid providers a route commercial providers do not have: clean claims filed electronically with a Medicaid HMO can be taken to the Department of Insurance and Financial Services under MCL 400.111i, on the same 45-day and 12% interest terms. We use it rather than waiting.
Auto injury reimbursement is capped at 190% of the Medicare amount payable since 1 July 2023, or 52.5% of the provider's 1 January 2019 charge where Medicare lists no amount, whichever is lower. Level I and Level II trauma centres and certain rehabilitation facilities carry higher percentages, and family-provided in-home attendant care is limited to 56 hours per week.
Nine Medicaid health plans hold CHCP contracts effective 1 October 2024 through 30 September 2029, awarded by Prosperity Region. MI Coordinated Health replaced MI Health Link for dual eligibles from 1 January 2026 in select counties, expanding statewide in 2027, and dual-eligible claims now route through it.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles CHAMPS enrollment, Medicaid health plan credentialing, no-fault claim pricing, prompt-pay interest recovery and denial resolution across Michigan, giving practices end-to-end RCM support in the state with the most complex auto injury reimbursement rules in the country.
Claims are scrubbed against CHCP plan and commercial payer edits before submission to drive clean first-pass reimbursement.
Every auto claim is screened for date of accident, PIP election level and remaining balance, then priced against both halves of the statutory cap.
We track the 45-day clock on every clean claim and pursue the 12% interest Michigan law attaches to late payment, rather than absorbing it.
Working knowledge of Blue Cross Blue Shield of Michigan, Priority Health, HAP, McLaren, Meridian, Molina and Upper Peninsula Health Plan submission protocols.
Whether you practise in Detroit, Grand Rapids, Ann Arbor or Marquette, our workflows adjust seamlessly as your group grows across Prosperity Regions.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, review whether your auto injury claims have been priced under the correct rules, and quantify the statutory interest your practice is owed on late-paid clean claims.
Under MCL 500.2006 a clean claim must be paid within 45 days after the health plan receives it, and a clean claim not paid within 45 days bears simple interest at a rate of 12% per annum. The plan must state any defect in the claim in writing within 30 days of receipt, and the 45-day period is tolled from that notice until the provider responds.
Reimbursement for auto injury treatment has been capped at 190% of the Medicare amount payable since 1 July 2023, having stepped down from 200% in 2021 and 195% in 2022. Where Medicare lists no amount payable, the cap is 52.5% of the amount the provider charged for that treatment as of 1 January 2019. The applicable limit is the lower of the two.
No, and this is the single most valuable question a Michigan practice can ask. Under the Michigan Supreme Court decision in Andary v. USAA the fee schedule does not apply to insured victims whose crash occurred before 11 June 2019, the effective date of Public Act 21. Date of accident, not date of service, governs.
Since 1 July 2020 drivers choose between unlimited coverage, $500,000, $250,000, or $50,000 if enrolled in Medicaid, and drivers with Medicare may opt out of PIP medical benefits entirely. Verifying the election and the remaining balance before treatment continues prevents care being delivered with no no-fault payer behind it.
Yes. Auto insurers are not obligated to pay for more than 56 hours per week of in-home attendant care provided by a family member or someone who ordinarily resides in the household, for care provided after 1 July 2021. The limit does not apply to care from a commercial agency nurse or in a residential facility.
Nine plans hold Comprehensive Health Care Program contracts effective 1 October 2024 and running through 30 September 2029: Aetna Better Health of Michigan, Blue Cross Complete of Michigan, HAP CareSource, McLaren Health Plan, Meridian Health Plan of Michigan, Molina Healthcare of Michigan, Priority Health Choice, UnitedHealthcare Community Plan and Upper Peninsula Health Plan. Awards were made by Prosperity Region, so plan availability varies by county.
We serve practices and healthcare facilities statewide across all ten Prosperity Regions, including Detroit, Grand Rapids, Warren, Sterling Heights, Ann Arbor, Lansing, Flint, Dearborn, Livonia, Troy, Kalamazoo, Saginaw, Traverse City and Marquette.
