This form or a prior authorization …

This page contains copies of forms commonly used by Medicaid providers. For Medicaid to reimburse the provider in this situation, MDHHS requires that the provider obtain authorization … Prior Authorization There may be occasions when a beneficiary requires services beyond those ordinarily covered by Medicaid or needs a service that requires prior authorization (PA). If you have any problems with documents found on this page, please e-mail us at MSA-FORMS@michigan.gov Michigan Medicaid Prior (Rx) Authorization Form To request Medicaid coverage for a non-preferred drug prescription in the state of Michigan, a physician will need to fill out a Michigan Medicaid prior authorization … Most forms are provided in both PDF and Word 2000 fill-in enabled formats. Medicaid Provider Forms and Other Resources. A standard prior authorization form, FIS 2288, was created by the Michigan Department of Insurance and Financial Services (DIFS) to simplify the process of requesting prior authorization for prescription drugs.


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