Noncontracted provider resources

Provider portal

Noncontracted providers can access the secure online portal for member eligibility, claims and remittance guidance. To set up an account, go to our log in page, select "Providers", then "Register" and follow the prompts.

Clinical criteria

Click here to view our referrals, authorizations and clinical criteria.

Prior authorization

Noncontracted providers are required to obtain authorization for all services except emergency. Prior authorization is not a guarantee of payment.

To request authorization, complete the forms below or call (313) 664-8950 then press option 1.

• Admissions and concurrent review
• Behavioral health
• Inpatient Rehab and Skilled Nursing Facility
• Outpatient medical services
• Benefit coverage policies
   

Important information for noncontracted providers

• Travel benefits for Medicare members - We provide our Medicare members with coverage when they travel.
• Merit Based Incentive Payment System Payment Adjustments for Non-Contracted Providers
• Reminder - Medicare Claims Pricer for Ambulatory Surgery Center Claims
• Provider – Waiver of Liability - To file an appeal, a noncontracted doctor or other noncontracted provider who has furnished a service to the enrollee must complete and submit the Waiver of Liability form with their appeal request. This form is required by Medicare and must be received before we can begin to process the appeal.