Have you accessed Molina's Provider Portal?
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Provider Field Services Department
Our Provider Field Services Department provides education and training to the provider community. This team also handles telephone and written inquiries from network providers for inquiries such as demographic changes, claims, credentialing assistance, and web portal assistance. This department has Provider Services Representatives who serve all providers in Molina Healthcare of Mississippi’s provider network. Providers may view the Provider Representative Map at the bottom of this publication to locate the
Provider Services Representative
that serves your local area.
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Prior Authorizations
The PA Code list, PA Guide and Request Form is located on our website under the "Forms" tab. Molina updates the PA Code list quarterly and as needed. Always use the list available on our website. Please do not print the list.
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OUR VISION
We envision a future where everyone receives quality health care.
OUR MISSION
is to provide quality health care to persons receiving government assistance.
OUR
VALUES
Caring
Enthusiastic
Respectful
Focused
Thrifty
Accountable
Feedback
One Molina
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Welcome to Molina Matters
Molina Healthcare of Mississippi
Provider Newsletter
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Hello Everyone!
I have been in the Chief Medical Officer position for just over a year and have watched and participated in the construction of Molina Healthcare of Mississippi from the ground up. I never thought I would be helping construct a health plan when I graduated from Med School 37 years ago. What an experience it was and is! Learning the lingo of Information Technology, Contracting, Networking and helping build and mesh the systems with the medical side, then launching the final product has been an eye opening and rewarding experience.
Now here we are –
up, running, and identifying what we need to change and tweak. We are adjusting a few things, but overall it has been a smooth launch. In order to ensure we are successful, we need to know what are your thoughts and what you have experienced collaborating with us. Communication is vital to making this system stronger and smoother and we consider it the utmost requirement to the health of our system.
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.
Molina Healthcare of Mississippi developed
Molina Matters
to better deliver important updates, news and resources to you on a quarterly basis. This tool is most effective when sent by email. However, we will also send this initial version by fax so that providers are aware and will benefit from the content. We aim to show the value of this newsletter and encourage providers to sign up for email delivery by using the information at the end of this edition.
Please contact us with any problems, suggestions, or ideas that you think may help us serve you better and in a more efficient manner.
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.
After all, we all have the same goal – that our members receive the healthcare they deserve.
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Provider News Section
The Provider News on our provider website is a valuable resource for providers. The Provider News houses the latest news, important updates and policy changes. We encourage all providers to check the provider news section daily to stay update-to-date.
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Provider Faxes
Urgent notifications will be sent to provider via fax. If you are unsure if we have a fax number for you, please contact Provider Services at
(844) 826-4335.
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Provider
Training Webinars
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Molina Healthcare hosts provider webinars each month. These free online presentations are open to network providers and staff. Frequent topics include provider orientation, provider web portal, billing, prior authorization, quality improvement, cultural competency, disability sensitivity, EPSDT, MYPAC, PRTF and much more! Invitations to attend will be sent to providers via email and fax. Topics, dates and how to RSVP is also available on our
Provider Website homepage. For more information, please contact your Provider Services Representative.
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Take a look at the value added benefits we offer to our MississippiCAN members at no extra cost to the member!
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- Free HealthinHand Phone App
- Free car seat program for completing prenatal visits
- No co-pays for any doctor office visit
- An extra $100 for frames and lenses
- Unlimited Office Visits
- Gift cards for postpartum and prenatal visits
- Gift card for receiving Mammograms
- Gift card for receiving yearly diabetic retinal eye exam and lab work
- Farm-to-Table program
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Molina has partnered with our payment vendor, ProviderNet, for Electronic Funds Transfer and Electronic Remittance Advice. Below are additional benefits and reminders:
Benefits:
- Providers get faster payment and eliminates mailing time (processing can take as little as 3 days from submission)
- Providers can search for a historical Explanation of Payment (EOP) by claim number, member number, etc.
- Providers can view, print, download and save a PDF version of the EOP for easy reference with no paperwork to store
- Transfer Protocol (FTP) and their associated Clearinghouse
- Electronic Funds Transfers ensure HIPAA compliance
- It’s a free service for you!
ProviderNet Reminders:
- ProviderNet is only for providers who have registered for EFT.
- Providers should always login to their ProviderNet account and view their payment history before contacting Molina about a missing EFT payment.
- ProviderNet only facilitates the payments from Molina to the provider. Questions regarding claims payment should be directed to Provider Services/Call Center.
- If a provider receives a Molina payment that is not on their ProviderNet account (frequently Accounts Payable payments), providers should contact Provider Services/Call Center.
- Providers should be reminded to add all NPI’s to their account that receive Molina payments.
Get started today! Providers that are not registered for EFT payments should contact: Electronic Funds Transfer at: (P)
1-866-409-2935
, Email:
EDI.Claims@Molinahealthcare.com
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Notify us when your information changes
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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)
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Confirm your demographics
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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.
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Newborn Delivery Prior Authorization Process Update
In order to help streamline our Newborn Delivery Prior Authorization (PA) process, Molina Healthcare of Mississippi no longer requires that a PA form is filled out and sent to us for a “normal newborn delivery” (CPT codes 59410 and 5951). Molina will now follow similar practices conducted by the other Coordinated Care Organizations (CCOs) contracted with the Mississippi Division of Medicaid (DOM) by creating an authorization number using the Newborn Enrollment Form sent to DOM.
If the expected stay of the member should exceed the “normal” three-day stay for vaginal delivery or a five-day C-Section stay, then a Molina PA form must be completed online at
https://Provider.MolinaHealthcare.com
or faxed to Molina at
(844) 207-1622
.
We expect this small change to have a significant impact on provider workflow efficiency and Molina’s timely response. If you have any questions regarding the change in process, please feel free to reach out to our Utilization Management Department at
(844) 826-4335
.
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Claim Management for Missing or Incorrect Member Information
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.
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Updated Standardized Pharmacy Prior Authorization Form
Molina Healthcare encourages all providers to review and utilize the updated Standardized Pharmacy Prior Authorization (PA) 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
.
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Clarification Regarding ADHD Diagnosis and ICD-10 Requirement
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.
For questions or more information, please contact Molina Healthcare at
(844) 826-4335
.
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Provider Portal Functionalities
The Web Portal is a secure site that offers Molina Healthcare providers convenient access, 24 hours a day, seven (7) days a week, to the following functions:
- Member Eligibility and Benefit Information: Users can verify member eligibility as well as view benefits, covered services, and members’ health records.
- Member Roster: Users can view a list of assigned membership for PCP(s) within the user's provider panel.
- Service Requests/Authorizations: Users can create, submit, and review Prior Authorization requests.
- HEDIS® Profile: Users can view their HEDIS® scores and search for members with needed services.
- Claims: Users can submit, correct, and void claims. Users can also check claim status, and view claims reports for all submitted claims.
You can register for and access the Web Portal by going to:
Providers will need their Tax Identification Number (TIN) and Molina Healthcare Provider Identification Number to register for the Provider Portal. Providers without a Molina Healthcare ID can email your
Provider Service Representative
for assistance.
For more information about the Web Portal, please review the
Web Portal Quick Reference Guide. For technical issues, contact the Web Portal Help Desk at
(866) 449-6848.
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Primary Care Provider (PCP) Member Roster
As a Primary Care Provider (PCP) for Molina Healthcare of Mississippi, you have access to your Member Roster which is available on our secure provider portal. It is the sole responsibility of the provider to review your Member Roster frequently to identify new and current members. To register for the secure provider portal or to view your Member Roster, please follow the provided instructions below.
The Member Roster application enables the registered user to view and navigate through a list of Members assigned to a PCP.
You will be able to:
- Customize Member search with built-in filters and sorting functions.
- View various statuses (e.g. needed services, inpatient, new Members, etc.) for Members.
- Check Member eligibility.
- Easily access other functions to view Member details, submit claims and request service authorizations.
If you need additional assistance, please contact your Provider Services Representative.
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Effective 10/11/18, Third Party Billers (3PB) have access to certain functions in the Provider Portal.
Molina contracted Providers may now grant access to their contracted third party billers who will be able to log into the Provider Portal. Once they are registered and granted access by a provider they can utilize the following functionality:
- Member Eligibility Inquiry
- Member Roster
- Claims (Inquiry & Submission)
To register a 3PB, the Provider Portal Account administrator for the Provider’s office must invite the 3PB via the “Manage Users” function. Once the new 3PB user is selected to Invite, the administrator will:
- Select “Biller” as the user role
- Attest to the Third Party Biller contract and BAA status
- Once the invitation is submitted, the 3PB will receive an invitation via the email address provided.
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Please note the following: The 3PB have the ability to toggle between multiple Pay-To groups from the same state with one user ID, similar to the non-3PB Biller role. If they need access to another state’s Pay-To group, they will need to create a separate User ID with a different email address.
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Please familiarize yourself and ensure you are using the Mississippi Division of Medicaid Preferred Drug List (PDL) as you prescribe medications for Molina Healthcare MississippiCAN beneficiaries.
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Influenza
Update
Xofluza™ (baloxavir marboxil) was approved by the Food and Drug Administration (FDA) to treat an acute influenza infection in people 12 years of age and older on October 24, 2018. In a phase 3 active- and placebo-controlled (parallel assignment) trial of 1,436 adult and adolescent subjects 12 to 64 years of age, there was no difference in the time to alleviation of symptoms between subjects who received Xofluza™ (54 hours) and those who received oseltamivir (54 hours) and for adolescent subjects (12 to 17 years of age), the median time to alleviation of symptoms for subjects who received Xofluza™ was 54 hours vs. 93 hours in the placebo arm....
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Drug Request
When submitting a Prior Authorization request, additional documentation of other treatment failures with preferred drugs must be attached. If no previous preferred drug usage is available, then additional medical justification must be provided. Please provide the treatment plan for this diagnosis including, but not limited to: pertinent medical history, relevant lab values, concurrent medications, treatment tried and reason (if known) for failure.
Please remember to fax all DRUG requests to our Pharmacy Services Department at
(844) 312-6371
. Requests that are NOT for DRUGS should be faxed to the Healthcare Services Department at
(844) 207-1620
.
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Our Community Engagement team host events and partner with other organizations throughout the year to help communities in Mississippi. We offer paid volunteer time off to encourage employees throughout our organization to lend a helping hand. We would love to include providers as well.
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Molina Healthcare attended the Picayune School District’s Early Head Start Health & Social Services Advisory Committee meeting held on Thursday, January 31
st
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The audience consisted of The Social Services Advisory Committee and Providers. The Mississippi Division of Medicaid gave updates regarding Medicaid, MississippiCAN and CHIP programs and introduced Molina Healthcare as the new Coordinated Care Organization. Ruth Powe, RN Sr. Quality Intervention Specialist at Molina, had the honor of presenting information about Molina and bringing insight to our history and benefits that we offer to our Members.
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Mind, Body & Soul Expo
In a continued effort to encourage local families to embrace healthy lifestyles, Molina Healthcare of Mississippi and the Jackson Department of Parks and Recreation partnered with other organizations to host the “Mind, Body & Soul” Health and Wellness expo. The event kicked off with a 5K run/walk and a 1-mile fun run for youth under the age of 12. Immediately following, guests received health education and information about various recreational programs and community resources.
Attendees of all ages exercised by making nutritious refreshments riding Molina’s popular smoothie bike, which powers an attached blender.
The bike promotes healthy eating and physical activity in a fun and engaging way! Dr. Cleo, Molina’s cat doctor mascot, was present to greet and take photos with the kids and their families.
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Molina Healthcare of Mississippi distributed reusable grocery bags filled with vegetables and gift checks for Thanksgiving in 2018
To fall into the season of giving and helping to feed the community this Thanksgiving season, Molina Healthcare of Mississippi hosted five (5) Thanksgiving Giveaway events. Molina partnered with Foot Print Farms to distribute over 700 reusable bags filled with vegetables as well as over 300 gift checks for a discounted turkey or any grocery item. These giveaways were hosted across the state in an effort to help feed those in need in every region we cover.
Events were held in : Jackson, MS; Meridian, MS; Yazoo City, MS; Olive Branch, MS; Gulfport, MS
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Share Molina Matters
Thank you for reading Molina Matters. Our goal is to reach everyone in your organization, and you can help by sharing and recommending this newsletter to your colleagues and partners. Any provider who receives a forwarded copy of this newsletter can subscribe to receive future editions directly by
clicking here
. Or providers can contact their Provider Services Representative or email
MHMSProviderServices@MolinaHealthCare.com
with a first and last name, email, plus your organization name. The newsletters are archived on our Provider Website. It is a pleasure to partner with you and we encourage you to stay connected with us.
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Provider Representatives
Please
click here
to locate your Provider Services Representative
Provider Services Contact Center
Phone: (844) 826-4335
Hours of Operations: M-F 7:30 am - 6:00 pm
Provider Field Services
Member Services
Phone: (844) 809-8438
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