Medicaid Abortion Claims - Required Forms and Clarification
We would like to provide important clarification regarding abortion-related Meridian Medicaid claims and required documentation considering recent provider inquiries and questions surrounding the Northland litigation.
This communication reflects Meridian’s policy based on state guidance and the requirements outlined in the MDHHS Medicaid Provider Manual (last updated July 1, 2025). To ensure claim submission and payment, Medicaid providers must fully complete and submit the MSA-4240 and the MSA-1550 forms prior to the submission of any abortion-related claims, when the abortion was necessary to save the life of the mother or resulted from rape or incest.
The required forms:
What is Required:
- Both the MSA-4240 and the MSA-1550 forms must be fully completed and submitted to Meridian before reimbursement can be made for any abortion procedure (excluding ectopic, spontaneous, incomplete, or threatened abortions).
- These forms must also be submitted when providers request authorization, as well as when billing the claim as an attachment.
- These documents confirm the acceptability of the abortion service and help reduce denials or requests for additional documentation.
- Forms may be submitted via fax or electronically.
Important Notes:
- The Northland litigation ruling does not apply to Medicaid.
- The MDHHS Provider Manual continues to outline this requirement for Medicaid. Providers should rely on the current manual for the most accurate guidance.
- Forms are not required for ectopic pregnancies or spontaneous/incomplete/ threatened abortions.
For further details, you may reference the MDHHS Medicaid Provider Manual.
If you have further questions regarding Meridian's policies regarding Medicaid abortion claims or the above forms, please contact us via the Provider Relations Inquiry Form.