Mclaren Health Plan Prior Authorization Lookup
- Mclaren Health Plan coverage criteria
- Mclaren Health Plan contact directory
- All Mclaren Health Plan policy updates
Latest Mclaren Health Plan prior authorization updates12
- Prior AuthAdministrative/Operational PolicyEff. 2026-06-01Preauthorization requirements and code list for McLaren Health PlanGoverns which services and codes require prior authorization from McLaren Health Plan across lines of business (Medicaid/Healthy Michigan, Health Advantage, Commercial/Community, Marketplace). Affects providers submitting claims and requesting authorizations.All mclaren health plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-04-01Service Codes Requiring Prior Authorization and Related Preauthorization RulesLists services, CPT/HCPCS/HCPCS-like codes and categories that require prior authorization across McLaren Health Plan product lines and notes product-specific exceptions (Medicaid, Healthy Michigan, Commercial/Community, Health Advantage); applies to providers and facilities submitting authorization requests.All mclaren health plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-02-01MHP Service Codes Requiring Preauthorization - Effective February 1, 2026Defines McLaren Health Plan preauthorization requirements by product/line of business and lists service categories and procedure/DME/pharmacy/genetic codes that require preauthorization; affects providers submitting authorization requests.All mclaren health plan updates
- Prior AuthClinical/Medical PolicyEff. 2025-04-01Site of Service for Eye and Gastrointestinal Outpatient ProceduresThis policy governs preauthorization and medical necessity review for performing certain eye and gastrointestinal outpatient procedures in an outpatient hospital setting versus an ambulatory surgical center (ASC) for McLaren Health Plan members across Medicaid, Healthy Michigan Plan, Commercial/Community, and Individual on Exchange products.All mclaren health plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-04-01Site of Service program (ASC vs outpatient hospital authorization requirements)Defines McLaren Health Plan's Site of Service program requiring certain surgical procedures to be performed in an Ambulatory Surgical Center (ASC) without authorization and requiring preauthorization and medical necessity review if performed in an outpatient hospital setting; applies to McLaren Health Plan Medicaid and Community/Commercial members and their providers.All mclaren health plan updates
- Prior AuthReimbursement/Payment PolicyEff. 2024-08-01Specialty Care Medication Site of Care/Infusible Updated Drug ListDefines McLaren Health Plan's Site of Care requirements for certain specialty injectable and infusible medications for Community and McLaren Health Advantage members, including reimbursement exclusions for hospital outpatient infusion centers and potential preauthorization requirements.All mclaren health plan updates
- Prior AuthClinical/Medical PolicyEff. 2022-02-01Update of Pharmacy Drug Coverage for Treatment of Obesity (GLP-1 receptor agonist medications)Updates Medicaid pharmacy coverage and prior authorization requirements for GLP-1 receptor agonist medications when prescribed solely for treatment of obesity; affects prescribers, pharmacies, and Medicaid beneficiaries covered under the referenced plan.All mclaren health plan updates
- Prior AuthReimbursement/Payment PolicyEff. 2015-04-01Reference laboratory billing for hospital laboratoriesRules for McLaren Health Plan contracted hospital laboratories billing for laboratory tests performed by external reference laboratories, including requirements for certification, contracts, and pre-authorization when applicable.All mclaren health plan updates
- Prior AuthAdministrative/Operational PolicyCommercial Medication Exception Review ProcessGoverns McLaren Health Plan's prior authorization (PA) and formulary exception process for commercial medications, describing how members and prescribers request standard and expedited reviews, internal review outcomes, and appeal pathways. Affects MHP commercial members, their prescribing providers, and PBM staff.All mclaren health plan updates
- Prior AuthClinical/Medical PolicyGenetic Testing Pre-authorization RequirementsThis document governs McLaren Health Plan's requirement that providers obtain pre-authorization for all genetic testing (including prenatal) and describes information the ordering practitioner must supply. It affects all McLaren Health Plan providers who order genetic tests.All mclaren health plan updates
- Prior AuthClinical/Medical PolicyPharmaceutical Management Medicaid 2026This policy governs McLaren Health Plan's Medicaid drug formulary administration, coverage rules (including prior authorization, step therapy, quantity limits, specialty and compounded medications), and provider procedures for requesting exceptions. It applies to providers and members under McLaren Health Plan Medicaid.All mclaren health plan updates
- Prior AuthReimbursement/Payment PolicyReadmissionThis document defines McLaren Health Plan's definitions and payment rules for hospital readmissions and transfers and explains submission and preauthorization responsibilities for hospitals across all lines of business.All mclaren health plan updates
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Tool Description
Search Mclaren Health Planprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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