Defense Health Agency-Great Lakes

For remotely located Active Duty and Reserve Component service members, the Defense Health Agency (DHA) - Great Lakes (fomerly known as MMSO) (DHA-GL):

• Gives pre-authorization for civilian medical care
• Authorizes payment of civilian medical claims
• Coordinates civilian health care services for remotely located service members
• Collaborates with unit representatives regarding line-of duty (LOD) care for remotely located service members

Request Forms

The forms below are submitted to the DHA-GL. Instructions and addresses are found on each form.

• Medical Eligibility Request—To verify your eligibility for medical care.
• Pre-Authorization Request for Medical Care—To get authorization for medical care
• Pre-Authorization Request for Surgical Care—To request authorization for surgical care.
• Formal Appeal Request—To submit a denied medical claim or pre-authorization request.
• DHA-GL 07 DVA/DoD MOA Initial Referral & Authorization for SCI-TBI-Blind Rehab
• DHA-GL 07a DVA/DoD MOA Continued Stay for SCI-TBI-Blind Rehab 
• DHA-GL 08 DVA-DoD SCI-TBI-Blind DME Request Worksheet
• DHA-GL 41 Worksheet DOD/VA MOA Inpatient-Outpatient Continued Stay Review

Instructions

Review the instructions below for DHA-GL processes and procedures.

• DHA-GL Process Guide
• How to forward medical eligibility documentation to DHA-GL   
• How to submit pharmacy reimbursement for Guard and Reservist with line of duty (LOD) injuries/illness 
• How to submit a request for pre-authorization for line of duty (LOD) care
• How to submit a formal appeal
• How to get a medical bill removed from a credit report
• How to submit Initial pre-authorization DVA DoD MOA
• How to submit Continuity of Care pre-authorization DVA DoD MOA 
• Information on the Fair Debt Collection Practices Act