Attention Medicaid DME providers. Effective 2/1/2023, authorization will be required for the DME items affected by bulletin MMP 22-40. A list of specific items is located in MDHHS bulletins MSA 20-14, MSA 20-25, and MSA 20-32.
Provider Preauthorization Forms
McLaren Health Plan
Medicare Preauthorization Form
Phone: (888) 327-0671
Medicaid and Healthy Michigan (810) 600-7959 HMO Commercial/ Community, POS Commercial/ Community, and Health Advantage (810) 600-7966
McLaren Medicare (833) 358-2404
Service Codes Requiring Preauthorization
Genetic Testing Preauthorization Requirements
For Medicaid Members: Authorization requests for genetic and molecular testing submitted more than 30 days from the specimen collection date/date of service will not be approved. Specimen processing should not be completed until after the authorization request has been approved.
Printable Provider Authorization Form
Note: Fields marked with an * indicates required field
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This referral is not a guarantee of payment. Please contact McLaren Health Plan to verify eligibility and covered benefits.
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IF YOU WOULD LIKE A COPY OF THIS REFERRAL FORM, YOU MUST PRINT IT (AFTER THE FIELDS ARE FILLED OUT). GO THE MENU BAR SELECT FILE THEN PRINT. ONCE HITTING SUBMIT, YOU WILL NOT BE ABLE TO OBTAIN A COPY OF THIS FORM. |