Michigan's Auto Insurance Utilization Review
Under Michigan’s new auto insurance law, medical care provided to auto accident victims must meet requirements for medical appropriateness. Auto insurers must establish utilization review programs to make these determinations, which can be appealed by health care providers to the Michigan Department of Insurance and Financial Services (DIFS) Utilization Review section. The rules governing Michigan's Auto Insurance Utilization Review took effect December 18, 2020.
Notice for Injured Persons: If you receive a notice related to Utilization Review appeals or determinations, that means that an appeal has been submitted by your health care provider. You are not required to take action. If you have questions or need assistance, please contact DIFS at 833-ASK-DIFS (833-275-3437) or firstname.lastname@example.org.
Health Care Provider Appeals
If a health care provider disagrees with a determination made by an auto insurer or the Michigan Catastrophic Claims Association (MCCA) about whether medical care provided to an auto accident victim meets the standards under Michigan’s new auto insurance law, the health care provider may appeal within 90 days of the date of the disputed determination from the insurer. Health care providers must file their appeal by completing the required No-Fault Utilization Review Provider Appeal Request (FIS 2356) form. The form must be submitted to DIFS by email at DIFS-URAppeals@michigan.gov or faxed to 517-763-0305.
An insurer or the MCCA may file a reply to the health care provider's appeal to DIFS no later than 21 days after the date of DIFS' notice of the appeal to the insurer or the MCCA. A reply from the insurer or the MCCA to an appeal must be submitted using the Insurer Reply to Provider Appeal (FIS 2361) form. The form must be submitted to DIFS by email at DIFS-URAppeals@michigan.gov or faxed to 517-763-0305.
DIFS will issue an order resolving the appeal to both the health care provider and the insurer or the MCCA. If DIFS requires additional time to complete the decision, written notification of extension will be provided to the health care provider and the insurer or the MCCA.
Note: DIFS decisions are based on documentation provided by both parties. All documentation relevant to the appeal must be provided with the No-Fault Utilization Review Provider Appeal Request (FIS 2356) form and the Insurer Reply to Provider Appeal (FIS 2361) form.
Auto Insurer Certification
By February 16, 2021, insurers must have in place a utilization review program that complies with the new administrative rules. DIFS' Application for Unconditional Certification of Auto Insurance Utilization Review Program (FIS 2362) must be filled out and submitted to DIFS for review and approval. The application must be submitted to DIFS by email at DIFS-URCertification@michigan.gov or faxed to 517-763-0305.
Additional information will be provided at a later date regarding certification renewal and annual information submission to DIFS.
Insurer Annual Report
Starting in 2022, auto insurers must submit a Utilization Review Annual Report (FIS 2358) to DIFS by March 31 of each year. Additional information will be provided at a later date about this requirement.
For insurers and health care providers:
Phone: 833-ASK-DIFS (833-275-3437)