Prior Authorization

There may be occasions when a beneficiary requires services beyond those ordinarily covered by Medicaid or needs a service that requires prior authorization (PA). For Medicaid to reimburse the provider in this situation, MDHHS requires that the provider obtain authorization for these services before the service is rendered.

The PA tab allows Fee for Service providers to submit single PA requests through the online web portal. CHAMPS validates both beneficiary and provider information. An error message is returned to the user if the information is incorrect. Any provider may request PA, however, the provider NPI entered in the servicing provider field must represent the provider who will be rendering the service. Once the PA request is successfully entered, the provider receives a tracking number. If the request is approved by MDHHS, this tracking number becomes the prior authorization number to use for billing purposes.

One of the following profiles is needed to access the PA tab: CHAMPS Full Access, CHAMPS Limited Access, Prior Authorization Access

To access a resource click on the preferred file hyperlink.

Overview

• PA (Prior Authorization) Tab - PDF, Webinar

102 Resources

• Prior Authorization Submission- Video
• Prior Authorization Inquiry- Video

Quick Reference Guides

• Prior Authorization: Inquiry

Additional Resources

• Beginner Guide
• CHAMPS FAQs
• CHAMPS Navigation Tutorial - PDF, Recording
• Prior Authorization Screen Navigation
• Fee-for-Service Medicaid Prior Authorization Guidelines
• Cell and Gene Therapy Access Model Coverage Criteria

March 2026 CHAMPS PA Changes

To align with changes outlined in policy bulletin MMP 26-02 the CHAMPS Prior Authorization (PA) screens will get a new look and feel to allow for more efficient processing. The process of submitting a PA through CHAMPS will remain the same. The CHAMPS screens will be updated as part of the March release on March 21, 2026. In the coming weeks MDHHS will be working to update provider resources to include the updated screen changes.

Below is a summary of additional changes, for complete details refer to MMP 26-02:

• Standard PA determinations submitted on and after March 22, 2026, will be made no later than 7 calendar days after MDHHS receives a request for services. Determinations can be extended by up to 14 calendar days upon request.
• Expedited PA determinations will be made no later than 72 hours after MDHHS receives the request.
• An annual performance report of PA statistics will be posted on this website by March 31, 2026.

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