The Meridian Michigan Pre Approval form plays a critical role in the delivery of healthcare services for Medicaid beneficiaries. It outlines a comprehensive process for prior authorization, detailing the need for healthcare providers to obtain approval before proceeding with certain services. This authorization is vital for the coordination of care and ensuring the provision of necessary, Medicaid-covered services. Providers have the option to submit requests via fax or phone, with many outpatient services being automatically approved through Meridian’s secure online Provider Portal. The document elaborates on services that require no prior authorization, ranging from allergy testing to routine X-rays, emphasizing ease of access to essential healthcare diagnostics and treatments. It also specifies procedures and treatments that necessitate corporate authorization due to their complexity or cost, such as elective surgeries and specialty drugs. The form further highlights the importance of notifying Meridian for emergency authorizations and out-of-network services to streamline patient care and reimbursement processes. Notably, the form addresses the parameters for outpatient mental health services, indicating a simplified initial access but a structured follow-up requirement. In addition to defining covered benefits, the form succinctly notes services that are not covered under Medicaid, thus providing clarity and guidance to healthcare providers in delivering care to Medicaid recipients. The Meridian Michigan Pre Approval form is a pivotal tool in managing patient care, ensuring both compliance with Medicaid requirements and supporting the health and well-being of beneficiaries.
| Question | Answer |
|---|---|
| Form Name | Meridian Michigan Pre Approval Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | meridian health prior authorization, meridian medicaid prior authorization form, meridian prior authorization, meridian medicaid |
AUTHORIZATION OVERVIEW
MEDICAID PRIOR AUTHORIZATION PROCEDURES OVERVIEW
You may forward your request to Meridian via fax:
Most outpatient services are auto approved via the secure Meridian Provider Portal at www.mhplan.com/mi/mcs.
No Prior Authorization (in or out of network)
Allergy Testing
Audiology Services and Testing (excluding hearing aids)
Barium Enema
Bone Densitometry Studies
Bronchoscopy
Cardiac Stress Test
Cardiograph
Chiropractic Services
Colposcopy after an Abnormal Pap
DME/Prosthetics and Orthotics ≤ $1000
Echocardiography
Endoscopy
Gastroenterology Diagnostics
Intravenous Pyelography (IVP)
Mammogram and Pap Test
Myoview Stress Test
Neurology and Neuromuscular Diagnostic Testing
(EEGs,
Obstetrical Observations
Routine Lab
Routine
Sigmoidoscopy or Colonoscopy
Sleep Studies (Facility only)
SPECT Pulmonary Diagnostic Testing
Primary Care Provider (PCP)/Specialist Notiation to Meridian (in or out of network)
Complex Outpatient Treatment
•Dialysis
•Outpatient Radiation Therapy
Maternity Care/Delivery
Notiication is needed for OB referrals and for OB delivery.
Specialist Oisits/Consults
Meridian Health Plan requests notiication to communicate services with all providers involved, provide additional reporting services and support Case and Disease Management eorts.
PCP/Specialist Notiation is not
Necessary for Claims Payment.
when the member is eligible and the service provided is a covered beneit under Michigan
Medicaid and the Medicaid MCO Contract.
Specialty Network Access Form (SNAF)
All referrals for Specialty Care at Hurley Hospital and Michigan State University must follow the SNAF process. Please contact the Meridian Care Management Department directly for referrals
to specialists at these entities. Meridian is required to complete a speciic referral form on
behalf of the PCP.
MeridianRx is the Meridian Pharmacy Beneit Manager. If you have questions about formulary or prior authorizations, please call
Corporate Prior Authorization (may require clinical information)
Ambulance Transportation
Cardiac Catheterization (heart cath)
Cardiac and Pulmonary Rehab
Chemotherapy and Specialty Drugs
• May require review under the medical or pharmacy beneit
DME/Prosthetics and Orthotics > $1000
Elective Inpatient/Surgeries and SNF Admissions
Elective Hospital Outpatient Surgery
(most auto approved at www.mhplan.com)
Hearing Aids
Hereditary Blood Testing (e.g., BRCA for breast and ovarian cancer)
Home Health Care
Hospice and Infusion Therapy
Infusions
Invasive Diagnostic Procedures (hospital setting)
•Hysteroscopy, Arthroscopy, Arteriogram, etc.
•This excludes any procedures listed in the No Prior Authorization
Required section of this document
Specialty Drugs (covered under the medical beneit)
•e.g.Rituxin and Remicade
•View a complete list at www.mhplan.com
Speech, Occupational and Physical Therapy
Weight Management (prior to bariatric surgery)
All emergency inpatient admissions, surgeries and
For emergency authorizations, Meridian must be notiied within the irst 24 hours or the following business day.
Ultrasounds
Urgent Care
Vision/Glasses
Voiding
*All DME supplies and chiropractic services should be provided by an
Outpatient Mental Health Services: No prior authorization is required for the irst 10 visits, but notiication from the Behavioral Health Provider to Meridian is requested for the second 10 visits. The Medicaid beneit is 20
outpatient mental health visits per calendar year. Please contact the Meridian Behavioral Health department for assistance at
Note: The above Prior Authorization Procedures refer to Medicaid covered services ONLY.