Msa 1680 b 2012 form-2025

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The document outlines the procedures for submitting a Dental Prior Authorization Request (MSA-1680-B) for Medicaid beneficiaries in Michigan. It specifies that private dentists and community dental clinics must complete the form for services covered under Medicaid and Children's Special Health Care Services (CSHCS). The document details the approval process, requirements for extensions, and necessary documentation, including x-rays. It also provides contact information for further inquiries.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Which types of procedures may need pre authorization under Medicaid?

For example, services that may require pre-certification include outpatient and inpatient hospital services, observation services, invasive procedures, CT, MRI and PET scans, and colonoscopies.

Does Michigan Medicaid require prior authorization?

Some services and procedures require prior authorization. Referrals and prior authorizations must be obtained prior to services being rendered.

What documents are needed for Medicaid in Michigan?

What to bring to your DHS appointment Proof of Income. Pay Stub(s) from the last 30 days. Bank Statement from the last 30 days. Social Security awards letter. Tax Return. Unemployment letter. Social Security Number. Identification. Drivers License. State ID. Proof of Address. ID with current address. Utility Bill.

What are the rules for Medicaid in Michigan?

To qualify for Medicaid in Michigan, your household income must be at or below 133% of the federal poverty level. Todays income limits for Michigan Medicaid are roughly $20,800 for an individual, $28,000 for a couple, or $42,800 for a family of four.

Does Medicaid use prior authorization?

States have authority over prior authorization practices in Medicaid and can implement prior authorization regulations that are stricter than federal requirements (Medicaid Health Plans of America (MHPA) 2023). Medicaid statute provides authority for utilization review in Medicaid ( 1902(a)(30) of the Act).