Prior Authorization (Part C)
What is Prior Authorization?
Prior Authorization is a process which must be completed before you get some services. Some services must get prior authorization, also called Prior Approval, before the plan will pay for it. Your doctor will make the request, you can make the request too. We will need medical records and notes from your doctor. Other information that shows why you need the item or service will be needed. Call your doctor if you need this information.
Which services require Prior Authorization?
To get a list of services that require prior authorization, please call Michigan Complete Health (MMP) at 1-844-239-7387 (TTY: 711). Hours are from 8 a.m. to 8 p.m., seven days a week. TTY users call 711. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.
For out of network services you must get prior authorization. You do not need prior authorization for emergency care, out-of area urgent care, or out-of area dialysis.
What is the process for getting Prior Authorization?
You may get prior authorization by calling Michigan Complete Health (MMP) at 1-844-239-7387 (TTY: 711) from 8 a.m. to 8 p.m., seven days a week. TTY users call 711. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. Providers need to send prior authorizations through the web portal, by phone or by fax.
If you need a quick response due to your health, ask for a fast coverage decision. You will be told if we approve the service within 72 hours after we get your request. You will be told no later than 14 calendar days for all other requests.
If we find that your health may be in danger we will hurry your request.
We will tell you what we decide in writing or by telephone. In the case of an emergency, you do not need prior authorization.
Prior authorization is not a guarantee of payment. The plan has the right to review the service for medical need after you receive the services. The member must be eligible for services. Some services have limits. Some benefits have exclusions.