MedicaidDocumentationMedium impact
MMP 22-42
Michigan Medicaid - MDHHS·MI·Provider Bulletin
Effective date
Feb 1, 2023
We identified it
Jun 20, 2026
Summary
Michigan Medicaid now requires a new attestation form (BPHASA-2210) for all claims and prior authorization requests related to clinical trial routine patient costs. Both the principal investigator and a qualified healthcare provider must sign this form, and it must be submitted with every clinical trial-related claim or PA request starting February 1, 2023.
Action Required
By February 1, 2023: For any patients participating in clinical trials covered by Michigan Medicaid, billing team must obtain completed BPHASA-2210 form signed by both the principal investigator and a qualified healthcare provider. Submit this form via CHAMPS Document Management Portal with all clinical trial-related claims and prior authorization requests. Update billing workflows to check for clinical trial participation and require this attestation form. Claims and PA requests without the completed form will not be covered.