Clinical documentation will be required for outpatient authorizations starting June 1

As Michigan’s Prior Authorization Reform legislation (SB 247 / PA 60) goes into effect on June 1, 2023, we’ll implement new requirements for some of our prior authorizations to help ensure timely, appropriate care for our members, your patients.

9-day turnaround time

Starting June 1, in accordance with PA 60, we’ll decrease our prior authorization turnaround time from 15 days to 9 days for our commercial, individual / ACA and governmental self-funded plans.

Clinical documentation requirement

To support this shift, also starting June 1, we’ll require in-network providers to upload clinical documentation supporting medical necessity to their medical and behavioral health outpatient prior authorization requests in GuidingCare.

This requirement, which will apply to all plans, will reduce the need for follow-ups requesting additional information, ultimately reducing administrative burden and wait times for your teams and ours.

Get more information

For more information on the work we’re doing to support PA 60, and the ways in which we’re already meeting the mark, see our recent news item.