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BAM 402 11 of 20 MA BENEFITS BPB 2021-026 10-1-2021

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

Local offices may obtain more information on medical/dental care coverage by consulting the MA provider manuals or contacting MDHHS at: Michigan Department of Health and Human Services Provider Inquiry CCC Bldg. PO Box 30479 Lansing, MI 48909-7979 Phone: 1-800-292-2550 MEDICAL/DENTAL SERVICES IN ANOTHER STATE MA A Michigan MA beneficiary may receive medical/dental care outside of Michigan. The areas beyond the Michigan borders are classified as either borderland or beyond borderland. Borderland and beyond borderland providers must comply with applicable Michigan MA policies and procedures, including prior authorization, to be reimbursed for services. Borderland Areas The borderland areas are the out-of-Michigan counties which are adjacent to the Michigan border and certain cities beyond these adjacent counties. The specific counties and cities which are borderland areas are:

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Page 11

Official source

BAM 402 11 of 20 MA BENEFITS BPB 2021-026 10-1-2021

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

Local offices may obtain more information on medical/dental care coverage by consulting the MA provider manuals or contacting MDHHS at: Michigan Department of Health and Human Services Provider Inquiry CCC Bldg. PO Box 30479 Lansing, MI 48909-7979 Phone: 1-800-292-2550 MEDICAL/DENTAL SERVICES IN ANOTHER STATE MA A Michigan MA beneficiary may receive medical/dental care outside of Michigan. The areas beyond the Michigan borders are classified as either borderland or beyond borderland. Borderland and beyond borderland providers must comply with applicable Michigan MA policies and procedures, including prior authorization, to be reimbursed for services. Borderland Areas The borderland areas are the out-of-Michigan counties which are adjacent to the Michigan border and certain cities beyond these adjacent counties. The specific counties and cities which are borderland areas are: