Please select a form from the options below: 

Provider Dispute Form (Dates of Services 3/31/22 and before)


Effective April 1, 2022, the following forms should be submitted through the new provider portal, the new website or via fax:

  • Michigan Provider Notification of Pregnancy form,
  • Training Attestation
  • Claims disputes (date of service 4/1 and after)
  • Prior Authorizations

Please update any bookmarks in your browser accordingly.

More information:

Provider Training page (

Manuals, Forms, and Resources (

Michigan Pre-Auth Check (

IL Meridian Provider Resources

MI MMP (MeridianComplete) Provider Resources

IL MMP (MeridianComplete) Provider Resources

Page Last Modified: 7/28/2022 12:31:39 PM