OSP News

Michigan’s Prior Authorization Statute: What Physician’s Need to Know

Posted: 04/26/2023

These reforms apply to health care insurers (and their contracted third-party vendors) and health care professionals whose beneficiaries/patients have commercial insurance policies regulated by the Michigan Department of Insurance and Financial Services. They do not impact Medicaid, Medicare, Medicare Advantage, or self-funded plans.

Check insurers’ provider news, updates, portals, etc. to learn of any new processes related to online submission, appeals, eligibility, and PA requirements related to the law’s implementation.

Key reform provisions include:

  • Electronic Submission – more details below
  • Timeliness of Decisions
  • Review by Peers
  • Clinical Validity
  • Transparency
  • Gold Carding

Electronic Submission

Beginning June 1, 2023:

  • Insurers must provide an online method through which practitioners can electronically submit PA requests for any benefits requiring PA, including prescription drugs. Facsimiles do not count as an acceptable method.
  • Physicians and other health care professionals must submit PA requests electronically. The only exception is for a temporary technological or electrical failure.

Click here for more information.

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