Michigan Medicaid Prior Authorization

Last updated: July 6, 2026.

Bottom line: Prior authorization (PA) in Michigan Medicaid has no single front door. The right route depends on who is responsible for the claim — fee-for-service (FFS) Medicaid, a Medicaid Health Plan (MHP), or the specialty behavioral health carve-out (a PIHP or its local CMHSP). The CHAMPS PA tab is the tool for fee-for-service PA requests. But if the beneficiary is enrolled in an MHP, or their care sits with the specialty behavioral health system, you follow that payer's process instead. So the first move is always the same: verify eligibility and payer responsibility, then choose your PA path.

Everything here is drawn from current MDHHS/CHAMPS pages as of the research date at the top — treat it as an operational map, not a substitute for the live pages and the current Provider Manual.

Prior authorization follows payer responsibility

Michigan Medicaid isn't a single payer behind one portal, so where an authorization request goes depends on how a beneficiary's coverage is administered. MDHHS's Mental Health & Substance Abuse provider page puts it plainly: who is responsible for mental health and substance use services "depends upon the severity of their needs and whether the beneficiary is enrolled in a particular program." So before anyone touches the CHAMPS PA tab, the real question is: which payer is on the hook for this client, for this service, on this date? Get that wrong and you can submit a perfectly clean PA to the wrong payer and still get denied.

And not every service needs a PA — MDHHS describes it as the process for a service "beyond those ordinarily covered by Medicaid" or one that specifically requires authorization, and for FFS the rule is to obtain it before the service is rendered. Whether a specific behavioral health service needs PA, and under which payer, is a detail to verify against the current Provider Manual and the responsible payer's policy — not from memory.

An important caveat: being enrolled in CHAMPS as a Michigan Medicaid provider does not automatically mean you're contracted or credentialed with a given MHP, PIHP, or CMHSP — network participation is a separate step. If a client's benefit lives with a managed care or carve-out payer, you generally need to be in that payer's network, and follow its rules, to get an authorization and get paid.

What the CHAMPS PA tab does

For fee-for-service Medicaid, CHAMPS is the electronic home for PA. The current CHAMPS Prior Authorization page describes:

• The PA tab allows fee-for-service providers to submit single PA requests through the online web portal.

• CHAMPS validates both beneficiary and provider information and returns an error if something is incorrect.

• Any provider may request a PA, but the servicing provider NPI you enter must be the provider who will actually render the service.

• Once a request is successfully entered, the provider receives a tracking number. If MDHHS approves the request, that tracking number becomes the prior authorization number you use for billing.

To use the PA tab, your CHAMPS user needs the right access profile — MDHHS lists three: CHAMPS Full Access, CHAMPS Limited Access, or Prior Authorization Access. Your organization's Domain Administrator assigns that role; the correct pattern is assigning the right role to the right user, never sharing one person's MiLogin/CHAMPS login. (MDHHS also offers a PA Request List view for looking up an existing PA by beneficiary when you don't have the tracking number.)

What changed in the March 2026 CHAMPS PA update

MDHHS updated the CHAMPS PA screens as of March 22, 2026, to align with policy bulletin MMP 26-02. As of the research date above, the live CHAMPS page describes the following — re-verify against the current page and MMP 26-02 before relying on them, and read them as MDHHS's stated processing standards, not a guarantee about any individual determination:

• Standard determinations: for requests submitted on and after March 22, 2026, MDHHS states a determination will be made no later than 7 calendar days after it receives the request, extendable by up to 14 calendar days when the provider requests it or MDHHS needs more information.

• Expedited determinations: MDHHS states these will be made no later than 72 hours after it receives the request.

• Returned PAs got easier. When a PA is returned for more information, providers can now upload the additional information directly to the existing PA request in CHAMPS (via the Provider Communication screen) — a new PA request is no longer required. The documentation attaches to the same request, keeping your tracking number and timeline intact instead of forcing a restart.

• Electronic submission is strongly encouraged through direct data entry in CHAMPS, though fax is still accepted; and because PA forms are being updated, always use the most current one on the Medicaid Provider Forms and Other Resources site.

These standards describe fee-for-service PA processing in CHAMPS. MHPs and PIHPs/CMHSPs set their own authorization timelines, which may differ — don't assume the 7-day / 72-hour standards apply to a managed care or carve-out authorization.

FFS PA vs. Medicaid Health Plan PA vs. PIHP/CMHSP PA

Here's the routing, side by side:

Fee-for-service (FFS) Medicaid → CHAMPS PA tab. MDHHS's guidance is to submit FFS PA requests electronically via CHAMPS. Note, though, that the published FFS Medicaid Prior Authorization Guidelines page is oriented around selected physician-administered drugs, surgeries, procedures, medical supplies, and equipment — not routine outpatient psychotherapy. For behavioral health, confirm in the Provider Manual whether a service is an FFS benefit that requires PA before assuming CHAMPS is your route. (MDHHS lists a Program Review Division line, 1-800-622-0276, for FFS PA questions.)

Medicaid Health Plan (MHP) → the plan's process. If eligibility shows the beneficiary is enrolled in an MHP, that plan owns the authorization for the benefits it covers. You submit through the plan's portal and follow its PA list and timelines — not the CHAMPS PA tab. Use MDHHS's Medicaid Health Plans page for the plan's contact/service listing and regional coverage.

Specialty behavioral health (PIHP/CMHSP) → the carve-out process. For more involved or severe mental health needs, and for Medicaid substance use disorder services, the specialty system is the gateway. Authorizations run through the responsible PIHP or local CMHSP — again, not CHAMPS — and you'll need to participate in that entity's network.

The takeaway: CHAMPS is the FFS PA tool, not the universal PA portal for all Michigan Medicaid — assuming every authorization goes through it is a common, avoidable billing mistake.

What to verify before you submit a PA

Before you request an authorization anywhere, run the eligibility and coverage check. MDHHS is explicit that the mihealth card does not contain eligibility information and does not guarantee eligibility — you must verify before rendering services. Use the CHAMPS Eligibility Inquiry (Provider Portal → Member → Eligibility Inquiry) or a 270/271 transaction, and confirm:

• Eligibility for the exact date(s) of service and the Benefit Plan ID(s). MDHHS says providers must use the Benefit Plan ID(s) in the response to determine coverage and covered services for that date; it's also where you see whether the beneficiary is FFS or enrolled in an MHP (the response can show the MHP Primary Care Physician when the date of service is the current date).

• Whether the service is a covered benefit that requires PA under the responsible payer's policy, and the documentation needed to support medical necessity.

• The correct rendering provider (the servicing NPI on a CHAMPS FFS PA must be the provider delivering the service), plus any third-party liability that may pay first.

Do this first and the "which PA process" question usually answers itself.

Tracking numbers, documents, and how PA affects claims

For CHAMPS FFS PAs, the tracking number ties everything together. Capture it immediately and store it with the client's record, and watch the status — a tracking number means "received," not "approved," and only approval turns it into the billable PA number. On the claim, use that approved PA number and make sure the service, dates, and rendering provider match what was authorized; a mismatch is a classic denial. (For MHP and PIHP/CMHSP authorizations, expect a different reference number and claim-linking convention — follow that payer's instructions.)

Action Steps for Providers

1. Verify eligibility for the date(s) of service in CHAMPS or via 270/271 — don't rely on the mihealth card — and read the Benefit Plan ID(s) to see which payer is responsible.

2. Confirm whether the specific service needs PA under that payer's current policy (Provider Manual for FFS; the plan or PIHP policy for managed care/carve-out).

3. Route the PA correctly: CHAMPS PA tab for FFS; the plan's process for an MHP; the PIHP/CMHSP process for specialty behavioral health.

4. Assign the right CHAMPS access role (Full, Limited, or Prior Authorization Access) via your Domain Administrator — not by sharing a login — and enter the correct servicing provider NPI on any FFS PA.

5. Submit electronically where possible; use the current PA form from the Medicaid Provider Forms page if one is required.

6. Record the tracking number and monitor status; for returned PAs, upload the additional info to the existing request (Provider Communication screen) rather than starting over.

7. Match the claim to the authorization — service, dates, rendering provider — using the approved PA number, and re-verify current rules (timing, scope, forms, MMP 26-02) on the live MDHHS pages before acting on anything time-sensitive.

Where Bomi Fits

Bomi doesn't replace MDHHS or your payers, and we can't guarantee that any authorization gets approved. What we can do is keep the operational side from slipping: track PA status across FFS, MHP, and PIHP/CMHSP routes, keep tracking numbers and returned-PA documents organized, watch determination timelines, and make sure the approved PA number lands on the matching claim.

Want help keeping Michigan Medicaid billing and credentialing workflows straight? Bomi helps therapy practices with eligibility checks, claims, denials, credentialing, payer follow-up, EOB review, and revenue operations so clinicians can spend more time with clients. Talk to Bomi about billing and credentialing.

This post is for general operational education and is not legal, compliance, or billing advice. Always confirm current MDHHS, Medicaid Health Plan, PIHP, CMHSP, and Provider Manual requirements before submitting enrollment, claims, or authorizations.

Sources

• CHAMPS Prior Authorization (MDHHS) — PA tab scope, tracking-number-to-PA-number, access profiles, and the March 22, 2026 (MMP 26-02) changes.

• Fee-for-Service Medicaid Prior Authorization Guidelines (MDHHS) — FFS PA scope and electronic-submission guidance.

• Beneficiary Eligibility Verification (MDHHS) — mihealth card caveat, CHAMPS Eligibility Inquiry, 270/271, Benefit Plan IDs, MHP/TPL data.

• Medicaid Health Plans (MDHHS) — plan contact and service listings and regional coverage.

• Mental Health & Substance Abuse — Providers (MDHHS) — FFS mild-to-moderate benefit vs. specialty carve-out routing.

• Michigan Medicaid Provider Manual (MDHHS) — authoritative policy detail; verify current chapters before any billing or coverage decision.

Related Bomi reading: our guides to [Michigan Medicaid eligibility verification](/blog/michigan-medicaid/michigan-medicaid-eligibility-verification) and [CHAMPS provider enrollment and MiLogin access](/blog/michigan-medicaid/champs-provider-enrollment-milogin).

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