Alert!

The COVID-19 pandemic is rapidly evolving. Molina would like to share resources and updates with our provider partners. Learn More.

Welcome, Mississippi Healthcare Providers

Contracted providers are an essential part of delivering quality care to our members. We value our partnership and appreciate the family-like relationship that you pass on to our members.

As our partner, assisting you is one of our highest priorities. We welcome your feedback and look forward to supporting all your efforts to provide quality care.

If you have any questions, please call Provider Services at (844) 826-4335.

Division of Medicaid Managed Care
2020 Provider Workshop Webinar

Attention All Providers!!! Fee for Service, MississippiCAN & CHIP 2020 Provider Workshop WEBINARS are coming!!!

The Division of Medicaid, in conjunction with its contractors Conduent, Alliant UM/QIO, and the MSCAN plans – Magnolia Health, Molina Healthcare and UnitedHealthcare Community Plan, will conduct "FREE" Medicaid Provider Workshop Webinars for specific provider types.

These workshops are designed to provide information and changes related to Medicaid and managed care programs. Office directors, office managers, coders, practitioners, and billing staff are encouraged to attend....

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COVID-19 Telehealth

Molina Healthcare of Mississippi is expanding telehealth services for Molina members to better protect you and our members from exposure to the COVID-19 virus. All providers with the ability to connect with patients through video or audio care are encouraged to do so.

Molina Healthcare of Mississippi will continue to follow the direction from the Mississippi Division of Medicaid regarding their Emergency Telehealth Policy for Medicaid and CHIP.

To view the Mississippi Division of Medicaid Emergency Telehealth Policy and additional information on Medicaid policies, coding, and reimbursement related to the COVID-19 outbreak, visit the agency’s resource page at https://medicaid.ms.gov/coronavirus-updates/.

 

Provider News

Coronavirus (COVID-19) Notification

What is COVID-19?

COVID–19 is a new strain of coronavirus, which originated in Wuhan City, China. The name COVID-19, is short for “coronavirus disease 2019.” This virus causes respiratory illness, and has infected thousands of people worldwide. The CDC and WHO are actively monitoring the outbreak of this new coronavirus strain. Visit the CDC’s Traveler’s Health website for travel notices and advisories.

What are the symptoms of COVID-19?

Common signs of infection include fever, cough, and respiratory symptoms such as shortness of breath and breathing difficulties. In more severe cases, this infection can cause pneumonia, acute respiratory distress syndrome, kidney failure, and even death.

People with heart and lung disease or weakened immune systems, as well as infants and older adults, are at higher risk for more severe symptoms from this illness.

How is COVID-19 spread?

Coronaviruses are generally thought to be spread most often by respiratory droplets. They are usually spreaded from an infected person to others through the air by coughing and sneezing, and through close personal contact such as touching or shaking hands.

Who should be tested?

 The Centers for Disease Control and Prevention (CDC) is telling clinicians to use their judgment in determining whether testing is necessary. They should consider the presence of symptoms (fever, cough, shortness of breath), travel history, contact with a confirmed COVID-19 patient and local epidemiology, and should rule out other potential causes of illness.

This expands testing to a wider group of symptomatic patients. Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza.

Epidemiologic factors that may help guide decisions on whether to test include: any persons (including healthcare workers) who have had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset, or a history of travel from affected geographic areas within 14 days of symptom onset.

When there is a suspected case of COVID-19, clinicians should immediately notify their state or local health department and implement infection control practices.

As availability of diagnostic testing for COVID-19 increases, clinicians will be able to access laboratory tests for diagnosing COVID-19 through clinical laboratories performing tests authorized by FDA under an Emergency Use Authorization (EUA). Clinicians will also be able to access laboratory testing through public health laboratories in their jurisdictions.

What billing codes are related to COVID-19?

CPT

U0001 - This code is used specifically for CDC testing laboratories

U0002 - This code is used for non–CDC testing laboratories

ICD-10

B97.29 - Other coronavirus as the cause of diseases classified elsewhere

Z03.818 - Encounter for observation for suspected exposure to other biological agents - ruled out

Z20.828 - Contact with and (suspected) exposure to other viral communicable diseases

RESOURCE REFERENCES CDC:

ICD-10-CM Official Coding Guidelines – Supplement. Coding encounters related to COVID-19 Coronavirus Outbreak. Effective: February 20, 2020.

WHAT MOLINA IS DOING TO HELP ITS MEMBERS:

Molina will waive co-pays and cost share for the diagnostic laboratory test for COVID-19 until December 31, 2020. (If the outbreak continues please monitor our provider notifications for potential extension of this policy). This policy will cover the test kit for patients who meet CDC guidelines for testing, which can be done in any approved laboratory location.

Molina will waive the member costs associated with this diagnostic testing for COVID-19 at any authorized location for all Medicare, Marketplace, and Medicaid lines of business. No Prior Authorization is needed for this testing.

Molina will offer zero co-pay and cost share for participating (PAR) telemedicine visits (where these are a covered benefit) - for any diagnosis until December 31, 2020. (If the outbreak continues please monitor our provider notifications for potential extension of this policy). Molina members should use telemedicine as their first line of defense in order to limit potential exposure in physician offices. Cost sharing will be waived for all video visits by in-network providers delivering synchronous virtual care (live videoconferencing) for those plans that cover this type of service.

Please contact Molina Provider Contact Center at (844) 826-4335 for more information.

Molina will waive co-pays and cost share for office visits, urgent care visits, and ED visits where the diagnosis rendered is specifically related to COVID-19 until December 1, 2020. (If the outbreak continues please monitor our provider notifications for potential extension of this policy). Visits for other symptoms or diagnoses will not have co-pay or cost share removed. This includes not removing cost share for other laboratory testing (besides COVID-19 testing), x-rays, or other add-on testing.

Molina will relax refill timing on all prescriptions until December 31, 2020. (If the outbreak continues please monitor our provider notifications for potential extension of this policy). Refill timing will be relaxed to allow refills up to 7 days early.

Molina will allow 90 day prescription volumes on medications.

Molina Nurse Advise Line will continue to be available 24 hours a day, 7 days a week at (844) 794-3638 TTY/TDD: 711.

 

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Important Reminder:

It is important to Molina Healthcare and your patients that your provider directory demographics are accurate. Please visit our Provider Online Directory at: providersearch.molinahealthcare.com to validate your information and notify us if there are any updates.

Please notify Molina Healthcare at least 30 days in advance when you have any of the following:

  • Change in office location,
       office hours, phone, fax, or email
  • Addition or closure of office location
  • ​Addition or termination of a
       provider
  • Change in Tax ID and/or NPI
  • Open or close your practice to new
       patients (PCPs only)

Appeals

Pre-Service Appeals

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

Post-Service Appeals

For providers seeking to appeal a denied claim only, fax Provider Claim Disputes/Appeals at (844) 808-2409.

If a provider rendered services without getting an approved PA first, providers must submit the claim and wait for a decision on the claim first before submitting a dispute/appeal to Molina. 

MSCAN Post-Service Appeals Form

CHIP Post-Service Appeals Form