Prior Authorization in Michigan
Soft Home Global provides authorizations submitted ahead of the date of service and chased to a decision for Michigan practices and billing companies at $1,900 per seat per month. Full time, worked during Michigan business hours, inside your own system.
What is specific to Michigan
Most Michigan Medicaid beneficiaries, including the Healthy Michigan Plan expansion group, are enrolled in contracted managed care health plans, and Blue Cross Blue Shield of Michigan remains the dominant commercial payer statewide.
Michigan’s Medicaid program is Michigan Medicaid. Practices with a meaningful Michigan Medicaid mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
Medicare here is adjudicated by WPS Government Health Administrators, jurisdiction J8 — shared with Indiana, but not with Ohio (CGS) or Wisconsin (National Government Services). CMS publishes the jurisdictions; checked September 2026.
What a prior authorization seat does in Michigan
Submitted before the date of service and chased through the payer's decision window.
An authorisation found after the visit is a write-off, not a denial to appeal. In Michigan the work is submitting ahead of scheduling and chasing the decision, against a payment clock that starts only once a clean claim lands.
- Authorizations submitted ahead of scheduling, not after
- Status chased rather than waited on
- Peer-to-peer reviews scheduled when required
- Clinical documentation gathered before submission
- Expiring authorizations flagged before they lapse
- Worked during Michigan business hours, not queued overnight
For the statute behind all of this — Michigan’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Michigan billing page.
Michigan Medicaid, in practice
Almost entirely comprehensive risk-based managed care — KFF counts 9 Medicaid MCOs in Michigan as of 2024, covering 2,362,189 enrollees, about 98% of the state's Medicaid population, leaving only a small fee-for-service remainder. Source: KFF
Michigan auto no-fault PIP is a distinct fee-scheduled payer no other state has. Since July 1, 2023, treatment of auto-accident injuries is permanently capped at 190% of the Medicare amount payable (it stepped down from 200% in 2021-22 and 195% in 2022-23), and payment may never exceed the provider's own average charge for that service on January 1, 2019. A Michigan practice must maintain a separate charge-history baseline and a Medicare-percentage pricing table just for auto claims. Source: FindLaw state code
For authorisations it decides who you ask. A carve-out means the rules, the portal and the turnaround belong to a different administrator from the one handling the rest of the member’s care, and an authorisation obtained from the wrong one is not an authorisation.
Working Michigan hours
Michigan runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
One wrinkle worth naming: four counties bordering Wisconsin run on Central time. If your practice sits on that side of the line, say so on the call and the shift is set to your clock rather than the one most of the state keeps.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Michigan hours and nobody else’s.
What it costs in Michigan
$1,900
Per seat, per month, in US dollars — $22,800 a year for one full-time person, forty hours a week, on Michigan hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Michigan run $1,500 to $2,500; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Michigan
About a week from a signed agreement to a person working your queue, and that week of training is not billed on top. The week, step by step, and what is signed before anyone has access.
If working with staff outside the United States is new to your practice, see how a medical billing company structures that seat and why offshore medical billing does not have to mean losing visibility into the work.
Questions
Do you work with Michigan practices?
Yes. Michigan accounts are worked during Michigan office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Michigan?
Most Michigan Medicaid beneficiaries, including the Healthy Michigan Plan expansion group, are enrolled in contracted managed care health plans, and Blue Cross Blue Shield of Michigan remains the dominant commercial payer statewide.
Which Medicare Administrative Contractor covers Michigan?
WPS Government Health Administrators, the A/B MAC for jurisdiction J8. Medicare Advantage and commercial plans run their own authorizations; for traditional Medicare, the hospital outpatient services on CMS’s prior authorization list are reviewed by this MAC.
When does a Michigan payer have to pay a clean claim?
45 days to pay a clean claim. The plan must tell the provider within 30 days of receipt every known reason the claim is not clean. Unpaid clean claims accrue 12% simple interest per annum. The authorization gets the service approved; this is the deadline for paying the claim that follows it, once that claim is clean.
How fast must Michigan Medicaid decide a prior authorization?
Under the federal CMS-0057-F rule, from 1 January 2026: 72 hours for an expedited request and seven calendar days for a standard one, for Medicaid fee-for-service and Medicaid managed care plans alike, counted in calendar time whether the request went by portal, fax or phone. The calculator at softhomeglobal.com/prior-auth-deadline works out the date.
How much does prior authorization cost in Michigan?
$1,900 per seat per month — $22,800 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Michigan queue?
Michigan is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Michigan Medicaid as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Michigan Medicaid has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
More for Michigan
Next step
One seat on your Michigan work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com