Michigan Medicaid Provider Credentialing Requirements

To avoid processing delays, providers are encouraged to ensure all required documentation is current and available at the time of application.

Required Credentialing Documents

1. CAQH Profile

A current and complete CAQH profile is required for all practitioners.

Important:

• The CAQH attestation date must be within the last 90 days at the time of submission.
• Doulas not currently listed in CAQH should create a profile and select "PTNL"  as their specialty designation until a specific doula specialty becomes available.

2. Professional Liability Insurance

Submit a current Certificate of Insurance (COI) showing active professional liability coverage.  Current requirements: $100K/$300K

3. State License

A current, unrestricted professional license for the state(s) in which services are provided.

4. DEA Registration and/or Prescribing Protocol

Required when applicable.

The following practitioners must provide one of the following:

• Current DEA certificate, or
• Written prescribing protocol/collaborative prescribing arrangement as permitted by state law.

This requirement applies to:

• Physicians (MD/DO)
• Advanced Practice Registered Nurses
• Physician Assistants
• DPM
• Dentists
• CRNA
• DMD

5. Hospital Admitting Privileges or Coverage Arrangement

Providers must submit:

• Current hospital admitting privileges, or
• A documented admitting coverage arrangement/admitting protocol when privileges are not held directly.

6. CLIA Certificate (If Applicable)

Required for providers or facilities performing laboratory testing or specimen collection services.

A current:

• CLIA Certificate, or
• CLIA Waiver

must be submitted when applicable. Michigan Medicaid requires offices providing laboratory services to maintain appropriate CLIA certification or waiver.

7. W-9 Form

A current and completed IRS Form W-9.

8. Credentialing Contact Information

Providers must supply current credentialing contact information, including:

• Contact name
• Organization
• Email address
• Telephone number

Providing a designated credentialing contact helps prevent processing delays and allows timely communication regarding application status or required follow-up documentation.