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Michigan Department of Health and Human ServicesPractitioner Special Services Prior Approval Request/Authorization Completion Instructions The MSA6544B must be used by Medicaid enrolled providers.

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A Michigan Medicaid prior authorization form requests Medicaid coverage for a non-preferred drug prescription in the state of Michigan. In this form, the physician provides their clinical reasoning for making this request instead of prescribing a drug from the Preferred Drug List (PDL).

You can contact Provider Support at any point if you need help by phone 1-800-979-4662 or email providersupport@Michigan.gov. 4.

Providers who have questions about the enrollment process or require assistance may contact the MDHHS Provider Enrollment Help Desk at 1 (800) 292-2550.

Your state's Medicaid contact information: Michigan.gov/MIBridges. Your state's Medicaid phone number: 888-367-6557.

For assistance in enrolling please call 1-800-292-2550 option 4.

If you have any questions, please call Provider Services at (855) 322-4077.

All PA requests should be submitted electronically, via CHAMPS. For questions regarding FFS Prior Authorization, call the Program Review Division at 1-800-622-0276. If CHAMPS is inaccessible, requests may be faxed to 517-335-0075.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232