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SPECIALTY PROVIDER ATTESTATION Michigan Department of Health and Human Services Maternal Infant Health Program Name of MIP Name of MIP Coordinator 1. Specialty population served by your MIP (check
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5651 mihp specialty provider refers to the form used to report specialized healthcare services provided by Medicare enrolled providers.
Providers who offer specialized services under Medicare are required to file 5651 mihp specialty provider.
Providers need to fill out the form with accurate information about the specialized services provided to Medicare enrollees.
The purpose of 5651 mihp specialty provider is to ensure proper reporting and reimbursement for specialized healthcare services under Medicare.
Providers must report details about the specialized services provided, including codes, dates, and any related documentation.
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