Michigan benefit summary language updates effective Sept. 1

August 2025

We’re updating the Michigan benefit summary to clarify what qualifies as medically necessary services and materials. These updates do not change your coverage.

What’s changing

• You’ll no longer need to request confirmation numbers for certain services
• These services will now be reviewed during the claims process instead
• To receive payment, you must include a valid medical diagnosis for claims 

Why this matters

• Reduces your administrative work 
• Speeds up access to care for patients
• Helps ensure consistency in how services are reviewed and approved

Starting Sept. 1, 2025, updated diagnostic code standards will be included in all medical procedure policies and available in the Provider Reference Guide.

You can still appeal denied claims or request a clinical review. Our Peer Review Committee will evaluate these based on medical necessity guidelines.