Medicaid prior authorization procedures overview you may forward your request to Meridian via fax: 313-463-5254

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Authorization Overview  


You may forward your request to Meridian via fax: 313-463-5254 or contact Meridian by Phone: 888-322-8844.  

Most outpatient services are auto approved via the secure Meridian Provider Portal at  

No Prior Authorization 

Allergy Testing 

Audiology Services and Testing (excluding hearing aids) 

Barium Enema 

Bone Densitometry Studies 

Brain Surgery* 


Cardiac Procedures* 

Cardiac Stress Test 



Chiropractic Services (in-network only

Cleft Lip Repair* 

Colposcopy after an Abnormal Pap 

DME/Prosthetics and Orthotics ≤ $1000 (in-network only



Gastroenterology Diagnostics 

GI Procedures* 

Hernia Repair* 

Intravenous Pyelography (IVP) 

Life-Threatening Emergencies (ER Screening) 

Lymph Node Surgery* 

Mammogram and Pap Test 

Myoview Stress Test 

Nerve/Tendon Surgery* 

Neurology and Neuromuscular Diagnostic Testing 

(EEGs, 24-Hour EEGs and EMGs) 

Non-Invasive Vascular Diagnostic Studies 

Obstetrical Observations 

Orbital Procedure* 

Orthopedic Replacement/Revision* 

Physical, Occupational, and Speech Therapy 

(evaluations only) 

Pulmonary/Vascular Procedures* 

Routine Lab 

Routine X-Ray (CT Scan, MRI, MRA, PET Scan, DEXA, 

HIDA Scans) 

Sigmoidoscopy or Colonoscopy 

Skin Graft* 

Sleep Studies (Facility only) 

SPECT Pulmonary Diagnostic Testing 

Spleen/Liver Procedure* 


Urgent Care 

Video EEG* 


Voiding Cysto-Urethrogram 

23-Hour Observation for In-Network Facilities Only 

(authorization required for elective services) 

Complex Outpatient Treatment 

• Dialysis 

• Outpatient Radiation Therapy 

Maternity Care/Delivery 

Notification is needed for OB referrals and for OB 


Specialist Office Visits/Consults 

Meridian Health Plan requests notification to 

communicate services with all providers 

involved, provide additional reporting services and 

support Case and Disease Management efforts. 

PCP/Specialist Notification is not Necessary 

for Claims Payment. 

In-network or out-of-network practitioners will 

be reimbursed for consultations, evaluations and 

treatments provided within their offices, when the 

member is eligible and the service provided is a 

covered benefit 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 specific referral form on behalf of 

the PCP. 

Primary Care Provider (PCP)/Specialist 

Notification to Meridian (in or out of network) 

Corporate Prior Authorization 

(may require clinical information) 

Ambulance Transportation (non-emergent) 

Anesthesia (when performed with radiology testing) 

Any Out-of-State Service Request (physician or facility) 

Bariatric Surgery 

Cardiac Catheterization (heart cath) 

Cardiac and Pulmonary Rehab 

Chemotherapy and Specialty Drugs 

• May require review under the medical or pharmacy benefit 

DME/Prosthetics and Orthotics > $1000 (faxed requests only) 

Elective Inpatient/Surgeries and SNF Admissions 

Elective Hospital Outpatient Surgery 

• Excludes those listed under No Prior Authorization 

• Most auto approved at 

Genetic Testing 

Hearing Aids 

Hereditary Blood Testing 

(e.g., BRCA for breast and ovarian cancer) 

Home Health Care 

Hospice and Infusion Therapy 


Specialty Drugs (covered under the medical benefit) 

• e.g. Rituxin and Remicade 

• View a complete list at 

Speech, Occupational and Physical Therapy 

Weight Management (prior to bariatric surgery) 

All emergency inpatient admissions, surgeries and 

out-of-network 23-hour observations require corporate 

authorization. For emergency authorizations, Meridian must 

be notified within the first 24 hours or the following business 


Out-of-network hospitals must notify Meridian at the time of 

stabilization and request authorization for all post-stabilization 


Non-Covered Benefits: The following services are not covered benefits under Medicaid and will not be reimbursed 

by Meridian: Aqua Therapy, Children’s Speech, Physical and Occupational Therapy covered under School Based Services, 

Community mental health services, Convenience Items, Cosmetic Services, Functional Capacity, Infertility Services and 

any other service otherwise not covered by Medicaid. 

Outpatient Mental Health Services: No prior authorization is required for the first 3 visits, but notification using 

the Continued Outpatient Treatment Notification Form (COTNF) from the Behavioral Health Provider to Meridian is 

requested for the remaining 17 visits. The COTNF form is located at  The Medicaid benefit is 20 

outpatient mental health visits per calendar year. Please contact the Meridian Behavioral Health department for 

assistance at 888-222-8041. 

Note: Prior Authorization Procedures refer to Medicaid covered services ONLY. 

MeridianRx is the Meridian Pharmacy Benefit 

Manager. If you have questions about formulary or 

prior authorizations, please call 866-984-6462. 

*These outpatient surgeries do not require authorization when performed at in-network facility. OON facilities require 

prior authorizations. 


All DME supplies and chiropractic services should be provided by an in-network provider. 

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