Providers can access comprehensive information about processes to file standard and expedited appeals, and submit provider claim disputes. Each section guides you on how to appeal decisions and understand your rights as a provider caring for patients enrolled in Molina MississippiCAN (MSCAN), CHIP, Medicare and Marketplace health plans.
Adverse benefit determinations encompass various actions, such as service denials, reductions, or limitations of services or payments, that providers need to be aware of when delivering and managing member care.
If you disagree with Molina about a denied Prior Authorization (PA) request for a Molina member, you can submit an appeal for review. During the appeal process, Molina will notify you of your rights, qualified professionals will review the case and Molina will communicate the outcome. If the appealed denial is upheld, you will be given information about further options.
An expedited appeal asks Molina to quickly review an adverse benefit decision involving hospital admission, continued stay or other health services if waiting for a standard appeal could seriously risk a patient’s life, health or recovery.
If you disagree with a denied pre-service (prior authorization) request for a patient enrolled in a Molina MSCAN or CHIP plan, you as their provider can submit an appeal on that member’s behalf with their written consent.
For providers seeking to appeal to denied Prior Authorization (PA) on behalf of a member only, fax Member Appeals at (844) 808-2407.
MSCAN Pre-Service Appeals Form
CHIP Pre-Service Appeals Form
If you chose to submit a written appeal and/or Grievance, it must be submitted to:
Molina Healthcare of Mississippi
C/O Firstsource
PO Box 182273
Chattanooga, TN 37422
Phone: (855) 882-3901
Fax: (877) 823-5961
For providers seeking to appeal a denied MSCAN or CHIP claim only, fax Provider Claim Disputes/Appeals at (844) 808-2409.
MSCAN Post-Service Appeals Form
CHIP Post-Service Appeals Form
If you provide services without getting an approved PA first, you must submit the claim and wait for a decision on the claim first before submitting a dispute/appeal to Molina.
Providers can request a review of previously processed claims, following Molina’s established redetermination procedures. This process ensures Molina handles claims disputes and adjustments promptly and transparently.
For more information, see our Provider Dispute Policies.