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Medicaid partners with others to support recovery efforts

Last weekend, southern regions of Mississippi suffered damage from severe weather and tornadoes, resulting in Gov. Phil Bryant declaring a state of emergency and President Donald Trump designating four counties federal disaster areas: Forrest, Lamar, Lauderdale and Perry counties.

The Mississippi Emergency Management Agency (MEMA) is continually reporting recovery updates such as fatalities, injuries, home damage, road damage, and power outages.

The Mississippi Division of Medicaid (DOM) has coordinated with the Department of Human Services to fulfill shelter duties and accommodate any shelter resident who has a disability or unmet needs. In cooperation with other organizations, DOM employees have reported for shelter duty starting at 6 p.m. on Tuesday, Jan. 24 through 6 p.m. on Friday, Jan. 27.

Additionally, from Jan. 21 throughout the duration of the State of Emergency, DOM has lifted prescription and durable medical equipment service limits for Medicaid beneficiaries in the affected areas. DOM’s Office of Pharmacy has specific emergency billing directions for beneficiary claims, for those beneficiaries residing in affected areas.

Fee-for-service Medicaid beneficiaries

During an officially declared State of Emergency, pharmacists must enter a value of ‘13-Payor Recognized Emergency’ in NCPDP Field ‘420-DK’ when it is necessary to override the following service limit edits:

  • 2 Brand/5 Prescription Limit
  • Early Refill

Please note, when a State of Emergency is declared, the fields noted above will be opened for the specified time period.

Pharmacy providers are advised to use professional judgment in emergency situations. DOM may conduct audits after such events to ensure appropriate care was taken in dispensing medications for affected beneficiaries.

Providers and beneficiaries who are not residing and/or receiving care in an evacuation area, must have documentation on file to justify rationale for early/excess prescription fills. Medicaid funds may be recouped if supporting documentation is not found.

Coordinated care beneficiaries (MississippiCAN)

Beneficiaries enrolled in our coordinated care program, MississippiCAN, should contact their coordinated care organization for assistance.

  • Magnolia Health: Call the Envolve Help Desk for overrides of service limits toll-free at 800-460-8988
  • UnitedHealthcare Community Plan: Call the OptumRx’s Help Desk for overrides of service limits toll-free at 877-305-8952