MedicaidAdministrativeLow impact
MSA 20-68
Michigan Medicaid - MDHHS·MI·Provider Bulletin
Effective date
Dec 1, 2020
We identified it
Jun 20, 2026
Summary
Michigan Medicaid now accepts electronic submission (fax and secure email) of Medical Verification for Transportation forms and Medical Transportation Statements with receipts for non-emergency medical transportation reimbursement. Original forms are no longer required but providers should keep copies for their records.
Action Required
If your practice provides non-emergency medical transportation services for Michigan Medicaid patients: Update your submission process to use fax or secure email for DHS-5330 and MSA-4674 forms instead of mailing originals. Ensure all receipts are still legible and itemized when submitted electronically. Continue to keep copies of all submitted forms and receipts for your records.