Provider News
01/03/19
Molina Healthcare would like to notify our provider partners of a change to the management of claims submitted with missing or incorrect member information. This communication is to assist you with any questions you may have.
Effective December 7, 2018, Molina will return any claims with missing or incorrect member information. The letter below indicates how providers will be notified of claims returned for missing or incorrect member information. Any returned claims will need to be resubmitted with the correct member information. These should not be submitted as adjustments.
Newborn claims are not subject to this return policy. The process for newborn information has not changed. Please continue to follow claim submission guidelines for all newborns.
Sample Notice for Returned Claims
Frequently Asked Questions:
What is this changing?
Molina will begin automatically rejecting claims up front when the member information is missing or is incorrect.
Why is this changing?
To support the need for accurate member records
When does this change take place?
Effective December 7, 2018 with new claim receipts
Will claims be denied?
Claims will be returned with a notice, not denied. The correct member information should be submitted to the member’s plan as a new claim submission, not as an adjustment.
What type of notification will be received for claims returned for missing or incorrect member information?
Please see the sample notice above.
What are the newborn claim submission guidelines?
Please refer to your billing guidelines. For additional information on claim submissions for newborns, please contact our Provider Services Call Center at (844) 826-4335.
Who do I contact with questions?
Please contact our Provider Services Call Center at (844) 826-4335.
Fall 2018 MississippiCAN, CHIP and Fee for Service Provider Workshops
10/31/18
Attention All Providers – 2018 Fall Workshops are coming your way!!!
The Division of Medicaid, in conjunction with its contractors Conduent, eQHealth and the MSCAN plans – Magnolia Health, Molina Healthcare and UnitedHealthcare Community Plan, will conduct Provider Workshops November 27, 2018 through December 12, 2018, at varied locations across the state. The purpose of these two-day Workshops is to provide updates and changes related to Medicaid and MSCAN. Office directors, office managers, coders and billing staff are encouraged to attend.
HELP US HELP YOU!
Please bring copies of claims and any issues your facility is experiencing to the Workshops. There will be a “Help Desk” available.
The following topics will be covered:
- MississippiCAN & CHIP Upcoming Changes
- Prior Authorization
- Retro Review
- Claims Review
- Dental
- Vision
- Non- Emergency Transportation
- Home Health & Wavier Services
- Durable Medical Equipment
- Hospital Services
- Newborn Services
- Third Party Liability
- Special Investigation Unit & Program Integrity
- HIPAA
Click the link below for more information regarding dates, times, locations and how to RSVP.
Fall 2018 MississippiCAN, CHIP and Fee-for-Service Provider Workshops
Clarification Regarding ADHD Diagnosis and ICD-10 Requirement
10/30/18
On October 1, 2018, the Mississippi Division of Medicaid (DOM) began requiring an FDA-approved indication or compendia-supported indication for each stimulant prescription.
Molina Healthcare transfers diagnosis codes from medical claims to our pharmacy claims processing system to allow for automated prior authorizations at the point of sale. Due to the delay in medical claims being submitted and processed and to ensure that stimulant prescriptions process without delays or the need for prior authorization, Molina Healthcare advises providers to write the diagnosis and ICD-10 code on each of their patient’s ADHD prescriptions. Pharmacy providers must then enter the ICD-10 code on prescription claims.
A list of FDA-approved or compendia-supported indications covered by DOM, along with corresponding ICD-10 codes, can be found on DOM’s Pharmacy Resource website page located at: https://medicaid.ms.gov/wp-content/uploads/2018/07/Stimulant-Approved-Indications-Coverage.pdf.
For questions or more information, please contact Molina Healthcare at 844-826-4335.
Updated Standardized Pharmacy Prior Authorization Form
10/26/18
Molina Healthcare encourages all providers to review and utilize the updated Standardized Pharmacy Prior Authorization form found on the Division of Medicaid’s website when requesting authorizations for Molina members for the use of non-preferred drugs. Please find all Pharmacy PA forms, including the Standard PA form, here: https://medicaid.ms.gov/providers/pharmacy/pharmacy-prior-authorization//.
If you have any questions or concerns, please contact Provider Services at (844) 826-4335.