AUTHORIZATIONS & REFERRALS

Each IHP PCP is responsible for coordinating the member’s total health care. All covered health services are either delivered by the PCP or are referred/approved by the PCP and/or the IHP. In addition, the PCP is responsible for initiating referrals for specialty care and maintaining continuity of care.

Some services and supplies require prior authorization by Ingham Health Plan in order to be covered. Certain services require medical review so that the Plan can determine if the service is a covered benefit and meets medical necessity criteria.

ONLY OUTPATIENT SERVICES COVERED – NO INPATIENT SERVICES

EMERGENCY DEPT SERVICES NOT COVERED

No authorization needed:

Office visits with your PCP or a Specialist

Routine outpatient diagnostic laboratory

Routine outpatient radiology services

Authorization Required before service:

Infusion Services

Injection Medications

Ophthalmologic exams and testing (Medically necessary - no vision services)

Outpatient Surgeries

Physical Therapy (12 visits per year)

Radiation Therapy

Needs a special review to determine coverage:

  • Genetic testing
  • Reconstruction Surgery
  • Skin Procedures
  • Vein Treatments & Surgery
  • Any service that could be considered cosmetic or not medically necessary
  • Unclassified procedure codes

Ingham Health Plan Authorization Request Form can be accessed through the IHP portal. Providers are required to login to access the form.


Follow IHPC:

ph: 866-291-8691

fax: 517-394-4590

planmanagement@ihpmi.org

P.O. BOX 30125
LANSING, MI 48909
© 2016 INGHAM HEALTH PLAN CORPORATION