Medicaid Eligibility Phone Number For Providers – We want to make sure you can easily get care from the right provider when you need it.

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Medicaid Eligibility Phone Number For Providers

Each member must have a primary care provider (PCP). Your PCP is an individual physician, physician group practice, advanced practice nurse practitioner, or advanced practice nurse practitioner group practice with training in family medicine (general practice), internal medicine, or pediatrics. Your PCP:

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Going to the same PCP each time you need care helps them get to know you and your needs. The more your PCP knows about you and your medical history, the better they can provide you with care.

If you have not yet selected a PCP, you can use our Doctor/Provider Finder tool or call Member Services to find a PCP online. If you are a new patient at your PCP, you should call to make an appointment. This will help your PCP understand your health needs more quickly. You must have your first visit within 90 days of joining.

Telemedicine is when you use your phone, computer or tablet to talk to a provider. Telemedicine is a convenient care option that reduces the risk of contracting diseases such as influenza. He can also give you quick medical advice to prevent your condition from getting worse. The use of telemedicine costs nothing and eliminates the stress of commuting to the doctor’s office.

Your PCP can provide telemedicine services through your phone or computer. You can talk to your PCP no matter where you are. Contact your PCP to learn about available options and for more information. Learn more about options for telemedicine visits.

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If you can’t see your PCP, we want you and your family to have easy access when you need care. A retail visit is faster than an urgent care visit or emergency room. You can get essential care at clinics located at CVS®, Kroger® and Walmart®. In the clinic you can:

Most clinics are open at night, seven days a week. Visits can be made on the same day. Entries are generally welcome.

Urgent care is for non-emergency situations. This applies if you can’t see your PCP right away. They can help prevent injuries, illnesses or mental health issues from worsening. If you think you need emergency care, you can:

If you are out of coverage, you may not be able to get care from your network provider. In this case, our plan will cover your urgent care from any provider in the United States or its territories.

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If you have an emergency now, please call 911 or go to the nearest emergency room. Emergency services are available for serious health problems that require immediate treatment. Pay for emergency services in and out of your county of residence. Examples of medical problems that require emergency care include:

If you are not sure whether you should go to the emergency room, call your PCP or the 24-hour nurse practitioner advice line. If you have more questions about where care is provided, please see your membership guide. By the end of 2023, there are two new developments important to carriers in the State of Mississippi (DOM). go on .

Eligibility Decision: Effective January 1, 2022, providers will no longer be required to be certified by each integrated care organization to participate as an enrolled provider in Mississippi’s CAN and CHIP programs. However, providers must be registered, verified and checked directly by the DOM. This new process eliminates the need for providers to obtain certification or recertification multiple times. Note, however, that the CCO may require the supplier to obtain different certifications if the supplier wishes to participate in a different line of work that the company may offer. Click here for more details and next steps from the provider

Update: Effective October 1, 2023, DOM will resume the provider verification process that was suspended during the federal COVID-19 public health emergency. We will send notification letters to providers registered for five years or more with instructions and deadlines for completing the update. Click to learn more

Facts For Providers Considering Medicaid Enrollment Post Covid 19

Relicensing and renewals require vendor registration to access the MESA Vendor Portal. Vendors who have not yet registered may register by visiting https://portal.ms–mesa.com/ and clicking the “Register Now” link.

All providers participating in MississippiCAN or the Children’s Health Insurance Program (CHIP) must be certified by the Mississippi Department of Health. Failure to complete certification/re-certification will result in termination of these programs. There are currently a large number of suppliers who need to be re-registered and the process should be completed before the end of the year.

In the 2021 Mississippi legislative session, Senate Bill 2799 was enacted to require coordinated care organizations (CCOs) to follow a uniform accreditation process. In the year On July 1, 2022, in light of this new requirement, the Mississippi Division of (DOM) amended the CCO contract to require CCOs to conduct the DOM carrier registration and verification process and not require providers to be certified by CCO or CHIP.

Beginning October 1, 2022, providers who wish to participate in Mississippian and/or CHIP must now register, be verified and vetted by the DOM and then contract with the CCO of their choice. As part of Enterprise Systems Assistance (MESA) implementation, DOM is implementing a new centralized accreditation process with an NCQA-accredited Centralized Certification Organization (CVO) responsible for accrediting and certifying providers seeking enrollment or currently enrolled in coordinated care. Program (MSCAN/CHIP). This new process eliminates the need for providers to obtain certification or recertification multiple times.

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CVO shall re-certify existing and new service providers every three (3) years unless the provider is certified by a DOM-approved delegation certification body. Providers who decide they require a re-referral will be notified by letter from Gainwell Technologies to the provider’s “mail to” address on the provider’s record. The letter was sent six months before MESA’s provider of record certificate expired, and a link to start the process was provided on the portal.

Facilities with multiple service locations and provider IDs will receive certification notifications for each provider ID. Just submit a credential application using one provider ID for the same tax ID and service address, and the application will receive credentials for all taxonomies for that location. If certification is denied or not completed by the certification deadline, all registrations for the facility at that location will be terminated and claims will not be paid. New applications for each service position must be re-registered in the Mississippi program.

Individual providers with multiple Provider IDs that share the same NPI will receive a reauthorization notification for each Provider ID. Providers only need to re-verify one ID to meet all ID requirements. If certification is denied or not completed by the certification deadline, all individual service provider registrations will be terminated and claims will not be paid. New applicants must re-enroll in the Mississippi program for each service location.

If you need assistance, please contact the Provider and User Services Call Center at (800) 884-3222 or use the Provider Field Representative List on the website to identify your designated representative. A list of supplier field representatives includes an email address and phone number for each representative. This resource file is located at https:///wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

Kentucky Medicaid: Prior Authorization Requests

Effective May 11, 2023, the U.S. Health and Human Services Commission (HHSC) has ended flexibility to extend carrier update dates set during the COVID-19 public health emergency (PHE). With the end of the public health emergency, the Mississippi Department of Health will resume the renewal process beginning October 1, 2023, requiring Mississippi registered providers to verify the information in their providers. The supplier’s certification is a requirement derived from 42 C.F.R. Section 455.414 of the Affordable Care Act (ACA) requires all state agencies to verify the registration of all providers at least every five years.

Revalidation requires the provider to confirm or verify the information in the currently registered provider file. Vendors must also complete and sign a new Vendor Disclosure Form and a new Vendor Agreement. As part of the verification process, the State must conduct comprehensive screening of providers based on their level of risk as described in 42 C.F.R. Section 455, Subpart B&E, and providers must comply with any requirements imposed by the State as part of the amendment process within a specified time period.

Notification letters will be sent to suppliers from October 2023

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