Msa115 form 2009-2025

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The document outlines the completion instructions for the MSA-115 form, which is used by Medicaid enrolled providers in Michigan to request prior authorization for occupational, physical, and speech therapy services. It details the necessary information required on the form, including beneficiary and provider details, treatment goals, and documentation requirements. The document emphasizes the importance of clarity and completeness in requests to facilitate processing and specifies the time limits for authorized therapy services.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (105 Votes)
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2009	4.2 Satisfied (60 Votes)

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