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 mimeridian.com 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 (mimeridian.com)

Manuals, Forms, and Resources (mimeridian.com)

Michigan Pre-Auth Check (mimeridian.com)

IL Meridian Provider Resources

MI MMP (MeridianComplete) Provider Resources

IL MMP (MeridianComplete) Provider Resources