MedicaidPrior AuthMedium impact
MSA 19-15
Michigan Medicaid - MDHHS·MI·Provider Bulletin
Effective date
Apr 1, 2019
We identified it
Jun 20, 2026
Summary
Michigan Medicaid updated their provider manual effective July 1, 2019, and added medication J1322 (Vimizim) to the Medicaid Health Plan Carve-out list requiring prior authorization for dates of service April 1, 2019 and after. Clinical Nurse Specialists are now recognized as qualified providers alongside nurse practitioners for various behavioral health services.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for J1322 (Vimizim) before administering to Michigan Medicaid patients. Update billing system to flag this medication for prior auth requirement. Claims for J1322 without prior authorization will be denied for services on or after April 1, 2019.