Provider Relations Portal

Thank you for contacting the HMSA Provider Relations Department.

These forms are in pdf format.
You may right click and choose 'save as' to download the form to your computer or click on the name of the file to fill out right away.


After your forms are filled out - Please fax them to Provider Relations Department at HMSA (313)962-0313 for processing.



OUR Pledge: We are committed to responding to your request within 24 HOURS Monday to Friday between 9-5!




Notice to Providers!

HMSA is currently recruiting providers to be on the Michigan Gambling Disorder Treatment and Prevention Provider Network as administered by the Michigan Department of Health and Human Services Department. If you are interested in joining this network to service clients who have gambling problems, send an email to: providers@hmsanet.com. Indicate in the subject line: Gambling Providers




Please choose from any of the following ways in which we can assist you:


Please do not email completed forms!!

  • PROVIDERS! Want to join our network? CLICK HERE!

  • Billing Claims questions? CLICK HERE!

  • Need Additional sessions? CLICK HERE!

  • Initial Referral packet.

  • Fax Cover Page

  • Business Associate Agreement



  • Looking for an Individual Form? CLICK HERE!




  •                   Join our Provider Network                                                        Update your current credentials


    Need additional assistance? Call (877)366-5552
    Monday thru Friday 9am - 5pm EST


    HMSA Corporate Center
    601 Washington Boulevard
    Detroit, Michigan 48226-3130