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Prior Authorization

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.  For providers using PA forms continue to use the most current version found on the Medicaid Provider Forms and Other Resources webpage. 

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

Quick Reference Guides

How to Request a PA

Prior Authorization Request List These slides navigate through general steps of submitting a PA request within the CHAMPS PA Request List screen. Note that additional pieces of information may become required based on the type of service and information submitted on the PA request. 

Additional Resources

March 2026 CHAMPS PA Changes

To align with policy bulletin MMP 26-02 the CHAMPS Prior Authorization (PA) screens were updated as of March 22, 2026 to allow for more efficient processing. Below is a summary of additional changes, for complete details refer to MMP 26-02.  PA related updates to the Medicaid Provider Manual will be made quarterly through 2025.

  • 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. Determination decisions can be extended by up to 14 calendar days upon request by the provider or when MDHHS requires additional information.
  • Expedited PA determinations will be made no later than 72 hours after MDHHS receives the request.
  • For Returned PA requests, providers may now submit the required additional information by uploading directly to the PA request in CHAMPS. A new PA request is no longer required for a Returned PA.  Refer to the Provider Communication screen.
  • Providers are strongly encouraged to submit PA requests electronically through direct data entry into CHAMPS however requests submitted via fax are still accepted.
  • All PA request forms are in the process of being updated. Providers must use the most current PA form available on the Medicaid Provider Forms and Other Resources website.

Fee for Service Prior Authorization (PA) Annual Reports

As required by the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F), the MDHHS reports fee-for-service Medicaid prior authorization data annually, as of March 31, 2026. To access the report click the hyperlink.

2025 Annual Reports:

  • Program Review Division (PRD): Report includes statistics for Prior Authorization Requests for Medical Services processed through the Program Review Division (PRD), including: admissions (hospitals, medical rehabilitation facilities, ventilator-dependent care units, long-term acute care hospitals), inpatient services, outpatient services, dental services, durable medical equipment, and medical supplies.
  • Home and Community Based Services (HCBS): Report includes statistics on Prior Authorization Requests for Home & Community Based Services processed through the Aging and Community Services Division, including Brain Injury Services and Community Transition Services (CTS).
  • Psychiatric Residential Treatment Facilities (PRTF): Report includes Prior Authorization Requests for Psychiatric Residential Treatment Facilities (PRTF) admissions processed through the Specialty Behavioral Health Bureau, Intensive Specialty Services Division.
  

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