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By becoming a presumptive eligibility provider, health care facilities can play a pivotal role in delivering early intervention services that contribute to positive maternal and infant health outcomes.
Effective 7/1/2024, diabetic supplies will be allowed to be billed on pharmacy claims. Diabetic supplies allowed to be billed via pharmacy claims are blood glucose meters and test strips, continuous glucose monitors (CGMs), disposable insulin pumps and components, insulin pen needles and syringes. Please see the MS Medicaid Diabetic Supplies Preferred Product List at -drug-list/.
On July 1, the Mississippi Division of Medicaid (DOM) will implement a single Pharmacy Benefit Administrator (PBA) to streamline and enhance the processing and management of pharmacy claims for all Medicaid members, including those enrolled in MississippiCAN and CHIP.
Operated by Gainwell Technologies, the PBA will also assume all pharmacy prior authorization responsibilities for drugs submitted on pharmacy claims. DOM will continue to require the use of the Universal Preferred Drug List (PDL). This decision comes after careful consideration and evaluation of various factors aimed at enhancing efficiency and transparency in the Medicaid delivery system.
Pharmacy providers must ensure their pharmacy software is configured to submit NCPDP D.0 pharmacy claims, with dates of service of 7/1/2024 and thereafter, for all Medicaid members (fee-for-service-FFS, MSCAN and MSCHIP) to Gainwell using the following billing values:
The Gainwell pharmacy call center phone number is 833-660-2402. This is a direct line to the Gainwell pharmacy help desk to aid with pharmacy claims and pharmacy prior authorizations. All pharmacy claims and prior authorization assistance should be directed to this number.
In an effort for a smooth transition to the single PBA, GWT has attempted to convert all MSCAN and MSCHIP PAs with approval dates in effect on/after 7/1/2024. In some cases, new PA requests may be required from prescribers.
Background: On May 11, 2023, the Health and Human Services Commission (HHSC) ended the extended revalidation dates for Medicaid providers that were implemented during the COVID-19 public health emergency (PHE). Following this, the Mississippi Division of Medicaid reinstated the revalidation process starting October 1, 2023. This requires all Mississippi Medicaid providers to verify the information in their provider files. According to 42 C.F.R. 455.414 of the Affordable Care Act (ACA), all state Medicaid agencies must revalidate provider enrollments at least every five years.
Revalidation Submission: Providers can revalidate through the MESA Provider Portal using a step-by-step process. It is crucial to submit the revalidation by the submission date in the notification letter to allow processing time before the deadline. Failure to complete revalidation by the deadline will result in termination requiring the provider to reapply.
The Mississippi Division of Medicaid (DOM) reimburses attested and qualified primary care providers at 100 percent (100%) of the Medicare Physician Fee Schedule for certain primary care Evaluation and Management (E&M) and Vaccine Administration codes. This applies to providers who self-attest to a specialty designation in family medicine, general internal medicine, obstetric/gynecologic medicine, pediatric medicine, or subspecialities recognized by the American Board of Medical Specialties (ABMS), American Board of Physician Specialties (ABPS), American Congress of Obstetricians and Gynecologists (ACOG), or American Osteopathic Association (AOA).
Providers should update their provider file, including updated or rescinding the primary care provider self-attestation form, with Gainwell when changes occur that impacts the information in the provider file.
A new email address has been created for submission of supporting documents related to provider enrollment applications, revalidations, and recredentialing. If a Gainwell Provider Enrollment Analyst requests missing or corrected documents via email or by a Return-To-Provider (RTP) letter, please send them to the new email address: ms_pe...@gainwelltechnologies.com. This will ensure the provider enrollment team receives your documents should you encounter issues uploading them through the web portal.
It is imperative for providers to promptly provide their updated licensure information to Medicaid, as failure to do so will result in the closure of their Medicaid provider number and interruption of claim payments.
Who is impacted?
Under the guidelines of 42 CFR 455.412, the Mississippi Division of Medicaid (DOM) is required to have current licenses in the provider file for both fee-for-service/MississippiCAN providers and CHIP providers.
If a provider fails to send in the updated license timely can a provider be reinstated?
Complying with the provisions outlined in the Mississippi Administrative Code Part 200, Chapter 4, Rule 4.5 (B) (C), DOM will reinstate closed provider numbers due to license expiration, retroactive to the date of license renewal, provided the closure duration is under one (1) year and the provider is not past due for revalidation or recredentialing. For this to happen, the provider must furnish a current license copy and rectify any changed or inaccurate information. If a Medicaid provider number has been closed due to license expiration for a period exceeding one (1) year, re-enrollment as a Medicaid provider will be necessary.
*Please note that the Change Request Form should not be used for reconsiderations of denied PAs. A separate process is utilized that typically involves a 1st level appeal and/or reconsideration request.
Managing PAs effectively is essential for seamless healthcare delivery. Using the Change Request Form to update or modify an existing PA ensures that patient care is not disrupted, and administrative processes remain smooth. By following the outlined steps and best practices, providers can efficiently handle necessary changes to PAs.
Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list to identify your designated representative at -content/uploads/2024/03/Provider-Field-Representatives-1.pdf. The Provider Field Representative list includes email addresses and phone numbers for each representative.
The Mississippi Division of Medicaid (DOM) will reprocess Professional Claims that denied with procedure code 99406 or 99407 for dates of service July 1, 2023 and after. DOM covers Tobacco Cessation Counseling in accordance with State Plan Amendment 23-0024, which allows 12 sessions per state fiscal year for MD/Nurse Practitioner/Physician Assistant when billed without a pregnancy diagnosis code. For all other providers, a pregnancy diagnosis code will be required. The reprocessed claims will appear on your Remittance Advice dated May 20, 2024.
Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list found at -content/uploads/2024/03/Provider-Field-Representatives-1.pdf to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative.
The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at -content/uploads/2024/03/Provider-Field-Representatives-1.pdf.
On July 1, the Mississippi Division of Medicaid (DOM) will implement a single Pharmacy Benefit Administrator (PBA) to streamline and enhance the processing and management of pharmacy claims for all Medicaid members, including those enrolled in MississippiCAN.
Pharmacy providers must ensure their pharmacy software is configured to submit NCPDP D.0 pharmacy claims, with dates of service of 7/1/2024 and thereafter, for all Medicaid members (fee-for-service, MSCAN and MSCHIP) to Gainwell using the following billing values:
The Gainwell pharmacy call center phone number is 833-660-2402. This is a direct line to the Gainwell pharmacy help desk to aid with pharmacy claims and pharmacy prior authorizations. All pharmacy claims and prior authorization assistance should be directed to this number.
Beginning October 1, 2022, providers seeking participation in MississippiCAN and/or CHIP are now required to be enrolled, credentialed, and screened by DOM, and subsequently contract with their CCO of choice. As part of the implementation of the Medicaid Enterprise System Assistance (MESA), DOM implemented a new centralized credentialing process along with NCQA certified Centralized Verification Organization (CVO) that will be responsible for credentialing and recredentialing Medicaid providers seeking to enroll or currently enrolled with our coordinated care programs (MSCAN/CHIP). This new process eliminates the need for a provider to be credentialed or recredentialed multiple times.
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