- Provider Information
- Billing and Reference Guides
- Claims and Member Information
- Claim Reconsideration and Appeals
- Clinical Practice Guidelines
- Cultural Competency Library
- Dual Complete (HMO-SNP) Program
- Electronic Data Interchange (EDI)
- Healthy Michigan Plan Health Risk Assessment (HRA)
- Pharmacy Program
- Provider Administrative Manual
- Provider Forms
- Reimbursement Policy
You'll find all forms we currently use in the following list.
We're currently reviewing all forms in an effort to make it easier and simpler to work with us, so check back frequently to see what's changed.
Dual Complete Prior Authorization List (PDF 282.37 KB)
Frequently Requested Forms
National Disclosure Provider Roster Addendum Form (PDF 42.73 KB)
Group Disclosure of Ownership and Control of Interest Form click here (PDF 519.75 KB) for PDF version.
Individual Disclosure of Ownership and Control of Interest Form click here (PDF 427.75 KB) for PDF version.
2016 Mileage Reimbursement Form (PDF 21.65 KB)
Waiver of Liability Statement (PDF 79.02 KB)