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: firstname.lastname@example.org. 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!!
Need additional assistance? Call (877)366-5552
Monday thru Friday 9am - 5pm EST
HMSA Corporate Center
601 Washington Boulevard
Detroit, Michigan 48226-3130