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Medicaid and Xerox Change Four Medical Review Forms

The Division of Medicaid, along with Xerox State Healthcare, LLC has made changes to four of its forms used by Medical Review. The forms are as follows: RTP (Return to Provider) Letters, Denial Letters, Consent EOB Codes, and Claims Reconsideration Form. The RTP letter, Denial Letter, and EOB Consent Codes will be used for correspondence with providers only if needed. If a provider has questions or wishes to submit a claim for reconsideration, the provider must complete a Claim Reconsideration Form; attach a paper copy of the claim in question, and any other substantiating information to be considered. The form with the aforementioned attachments must be mailed to the following address:

Xerox State Healthcare, LLC
P.O. Box 23080
Jackson, MS 39225

For more information concerning these changes, please visit the Mississippi Medicaid web portal under “What’s New” . If you have any additional questions, please contact Xerox Provider and Beneficiary Services toll-free at 1- 800-884-3222.