Claims/Referral Administration

In this section you will find information about submitting referrals and obtaining plan approval and submitting claims by paper and electronically.

Referral Administration

The medical management program is comprehensive and includes:

• referral management
• plan approval
• inpatient admission review for plan approval with length
  of stay assignment
• concurrent review
• discharge planning
• case management
• specialized clinical programs

Prior Authorization Requirements

Michigan HealthCare Referral Form

Provider Reconsideration Form for Pre-Service and Post-Service Appeals
(including form instructions)

Request for Additional Pain Visits

Prior Plan Approval for Infertility Services Form

Claims Administration

Submitting Claims via EDI

Submitting Paper Claims

Provider Claims Review Request Form - Use this form for corrected billing, claims disputes, late file limits appeals and refunds. Utilization of this form will enhance turnaround time and accuracy on your claims and refund requests.

Provider Appeal Process

Mediation of Facilitation of Disputes