Clinical & Payment Policies
Clinical policies are one set of guidelines used to assist in administering health plan benefits, either by prior authorization or payment rules. They include but are not limited to policies relating to evolving medical technologies and procedures, as well as pharmacy policies. Clinical policies help identify whether services are medically necessary based on information found in generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by the policy; and other available clinical information.
Provider Education
Meridian offers trainings for both behavioral health and physical health providers in our network at no cost. Our team provides mostly clinical, provider-focused education on topics that are geared towards improving member outcomes. The majority of our clinical trainings also offer behavioral health continuing education units also at no cost to the attendee. Trainings are completed via live/virtual instructor led webinars.
Ongoing Reminders
Meridian (Medicaid) and MeridianComplete (MMP) Ongoing Reminders
- Update your info with the Demographic Update Tool whenever changes occur.
- Submission requirements for unlisted or not otherwise classified (NOC) codes - Supplemental Materials
- Fax Submission of Appeals - Supplemental Materials
- Provider Network Bi-Weekly Orientation Schedule
- Redeterminations - The Michigan Department of Health and Human Services (MDHHS) resumed conducting the annual renewal process on April 1 2023. We are now in the final month (May 2024) for renewals.
- Musculoskeletal Prior Authorizations switched to Evolent on April 1st, 2024
Ongoing Reminders from Michigan Meridian (Medicaid)
- Per the MDHHS Medicaid Provider Manual, Meridian is making updates to the Speech Therapy Prior Authorization Policy. Effective May 1, 2024, Prior Authorization will be required for speech therapy visits greater than 36 in a calendar year
Ongoing Reminders from Michigan MeridianComplete (MMP)
