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What is a Michigan DHS 4487 form? The DHS-4487 is mailed during the month prior to the redetermina- tion month for active recipients when a match is found with IRS. Specialists are sent a task/reminder which identifies the client who received notices.
What is the fax number for University of Michigan referral?
For insurances requiring a referral or authorization from the primary care physician, please fax the referral to 734-936-8067. The information listed above is required before an appointment can be scheduled for your patient.
What is the fax number for Michigan medicine referral?
For insurances requiring a referral or authorization from the primary care physician, please fax the referral to 734-936-8067.
What is the fax number for musc referral?
Please fax the completed request form to (843) 792-2995 along with relevant medical records.
What is the fax number for Blue Cross complete of Michigan?
Submit completed forms and requests to Provider Network Operations at: bccproviderdata@mibluecrosscomplete.com or fax to 1-855-306-9762.
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Michigan DHS formsU of M referral form PDFMichigan DHS 431 formUniversity of Michigan referral formMI Bridges LoginDHS forms onlineMichigan Medicaid application formMichigan DHS 20 form
Send change forms to: Email: MHMContractConfig@MolinaHealthcare.com. Fax: 248.925.1757. Mail: Molina Healthcare of Michigan. 880 West Long Lake Road, Suite 600.
In addition to the referral line, MSU Health Care has a global referral form. The form can be used to refer patients to any of the MSU clinics by faxing the
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