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MESA Provider Portal FAQs

New FAQs added in response to Nov. 17 workshop

1.Is it one year for a correct claim or appeal?

It is one year for a correct claim. Appeals are separate and are handled on a one-on-one basis.


2. I have called the call center for a repeated denial I am getting. I was informed they are not trained on claim denials.

This will be addressed with the call center. If you cannot get assistance from the call center, providers are able to reach out to their assigned representative. As part of training, there have been weekly refresher trainings with the call center staff, and this will be addressed within the next meetings.


3. Dental ICD 10 codes are new, and many providers are confused. Can someone speak to this?

There is a “Late Breaking News” bulletin that specifies as of October 3, 2022, the Division of Medicaid has set up that dental claims require a valid diagnosis code. The bulletin gives a range of ICD-10 diagnosis codes that can be used.


4. Does the claim number have different starting numbers for VOID, corrected, and crossover? What were the numbers when you were showing within the void section during the webinar?

A claim that has the first two digits of “22” is a web portal claim. When you see a claim number that has the first two digits of “59” or “69”, that is a claim that has been adjusted or voided. We also refer to this as the daughter claim.


5. Which box does the ICD-10 code go into on the claim?

Go to the DOM website.  Go to the MESA portal. There is an entire video that will guide you on how to submit claims. It will guide you step-by-step on how to input that information. Here is the link to the location on the portal:   .


6. Can we send our claim via paper with prime remit for payment? For the ones past timely that are denied, can these be sent in by paper?

Any claim can be sent in by paper as long as it is sent on a CMS 1500 or UBL4 claim type. If you are sending in a Medicare Crossover, you can send them in with a remit from a third-party insurance, like United Healthcare, etc. If it is a Medicare C, make sure you submit the full remit for the Medicare C payer. As for the timely filing, you can submit those as paper with an attachment as to why it is coming in late, so it can be reviewed and processed.


7. When will the PWK guidelines be available for electronic secondary claims?  The EDI Companion Guide does not state where to send EOMB’s (only provides loop/segments).  In a previous meeting, it was mentioned that the EOMB could be faxed or mailed.

We are hoping to have this rolled out by the end of the month.  We are currently in the process of testing it, and we will have it out soon.


8. Secondary claims to commercial primary are denying for no authorization. Since Medicaid is secondary, authorizations should not be required. How can this be resolved?

If they are saying that Medicare doesn’t cover it, that means that it comes to Medicaid is primary. We should be requiring prior authorization because Medicare didn’t require one, which means one was probably not obtained.  If it truly processed as a crossover claim (make sure that it did come to us as a crossover claim), then it should not require prior authorization. We would need to see an example of this claim to further answer.


9. If it is commercial insurance (for example, they have Blue Cross Plan) but our service requires prior authorization and Blue Cross pays on the claim, and we are just secondary, do we require EPA?

At this point in time, commercial insurance does not override the need for a prior authorization for Medicaid. Only Medicare crossovers as the secondary can bypass the prior authorization. Any primary private insurance will not bypass prior authorization automatically.


10. How do we resolve claims that deny stating, “Bill Medicare first”, although patient was over 65 but no Medicare coverage was found?

This is actually per DOM policy that any member over 65 is required to have Medicare to keep Medicaid.  So, the provider would have to go back to the member to get the Medicare number.


11. We have had a few claims that when submitted on the portal and keyed in the primary insurance adjustment, the portal auto calculated a different allowable than what the primary EOB shows.  Therefore, Medicaid paid more than the primary left to co-insurance, or we think Medicaid may have paid incorrectly due to the adjustments applied to the primary EOB. What should we do about this?

If it is a Medicare crossover claim, it is not based on what the primary EOB is stating based on the co-insurance and deductibles. If it is primary insurance, the Medicaid doesn’t take into account the amount that the other insurance is stating but it takes into account what the policy is for Medicaid, which is to pay the allowed amount minus what the other insurance has paid.


12. Can we bill a T code and a 5445 on the same claim?

If talking about incontinence supplies, they should not deny being billed together. You should be able to bill T4528 and A5445 together. If this causes a problem, let us know, so we can take a look at it.


13. If Medicaid paid more than what the primary leftover to be paid, do we need to void the claim or correct the claim because it leaves a credit in the patient’s account?

If it is a Medicaid claim, the provider cannot adjust a Medicare claim. For crossover claims, which are Medicare claims, the provider can only void it. You can only void a Medicare claim. If it is other insurance, you can void it or adjust the claim accordingly.


14. The web portal does not indicate whom the OHI (other health insurance) payer is. We have examples of Medicare Managed Care plans as primary and Medicare (over age 65) as primary, however the OHI on the eligibility is blank (MESA would have this info). Conduent provided any OHI payers they had on file for the members even if the payer had termed. We have not found one patient on the MESA portal that showed OHI on the eligibility screen. Is this an issue that needs to be addressed?

In the old system, the portal would tell what type of insurance the patient had as well as the begin date or end date of that particular insurance schedule. The new system, MESA, does not show that currently, yet this may be an enhancement coming down the line at a later time. If it is blank, the member does not have other health insurance (OHI). Only when the member does have OHI, that information is shown. This was covered on a previous webinar. Medicare is not considered other insurance. Other insurance is only for “commercial” insurance information.


15. Can a provider see a broader/longer span of member’s eligibility?

Yes. Go to “Home” page. Scroll to bottom left side and select “Member Focused Viewing”. Enter the Member’s ID and click “Search”. Then, select the member from the Search Results. A panel will display that provides more detailed information of a member’s eligibility.


16. Why are we not being paid for mileage?

Medicaid and Gainwell are aware of errors related to mileage code A0425. This is being worked on to allow mileage when billed with A0427.


17. Is MESA going to reprocess the A0425 for processing, or are we going to have to resubmit these to get paid?

Once the correction has been made, providers will need to re-submit impacted claims.


18. Where can we find the carrier codes?

Go to the home page of the Mississippi Division of Medicaid at, and under the provider portal please note your claim will not be denied for having the wrong carrier code.


19. What do we do if we cannot find the carrier codes?

If you are unable to find a carrier code, then please enter the name of the carrier in that field.


20. Are the Medicare carrier codes available?  If so, where is the information posted?

We are looking into creating a carrier code list. Additionally, we are working on updates to ease some of the required information to be entered.


21. Can someone explain the PWK form for Medicaid, or is this something we do on the portal when submitting claims?

The PWK is a segment in an Electronic Claims Submission. You will use this only if you are submitting batch claims through an EDI processor.


22. We are having issues with our DME paper claims that are submitted through the portal.  We have attached MSRPs for all of them and half of them pay as they should.  We then have others that deny saying the claim is missing the attachment, but when you pull up the claim there is an MSRP attached.  However, the error code states no attachment.  How do we fix this?  These are extremely time consuming to submit.

We are looking into this and will update within “Late Breaking News”.


23. Our DME crossover claims are continuously denying for duplicate claim.  Previous Dates of Service do not overlap.  Claims will pay one day and deny the next despite being entered and submitted the exact same way.  We have no consistency.  What is being done to address this?

This is something that is being looked into for all DME providers. More information will be forthcoming as more research and possible corrections are done. Pay attention to “Late Breaking News”.


24. We have claims that were submitted and processed by Conduent that need to be corrected (changes to charge and/or refunds due to Medicaid).  We are unable to locate the claims on the web portal.  Is there an ETA on updates for this issue?

We are still working on the process of voiding a claim with a Conduent claim in Gainwell’s system. There will be more updates on this matter.  Pay attention to “Late Breaking News”.


25. Where is the billing done…county?

The billing is done from our individual offices in each of those counties.


26. Are the training videos on MESA or Gainwell?

The training videos can be found on the DOM homepage:


27. Do we need to create an account with Gainwell?  We have been given conflicting answers for this.

Yes, you need to enroll with Gainwell.


28. Does each office do its own billing, or does it go to a clearinghouse to be submitted to Gainwell?

Each office submits to a clearinghouse.


29. What is the correct Gainwell portal site? 


30. If we send them on paper and attach a letter as to why it is timely, does this letter need to be attached to each claim?  Or can we send one letter with a batch of paper claims?

There will be more to come on timely filing processes.  You need to include a copy of the supporting documentation with each claim.  You may attach one letter for all the claims you feel timely filing should be reconsidered.  Mail these to: Division of Medicaid, P.O. Box 23076, Jackson, MS 39225.


31. Will there be a webinar to go over commercial secondaries step-by-step? 

Yes, that will be in an upcoming webinar.


32. Can we still submit Part C crossovers on the MESA portal, or do they need to be mailed? We have had all our secondary claims to Part C denied. These are mainly co-pay amounts. Will Medicaid pay for co-pays? 

You can submit Medicare C through the portal just like a Medicare Crossover, but instead of a Filing Indicator of MA or MB, you will use 16.   You can submit Part C claims via Web Portal.  Make sure to use the Filing Indicator -16.  Note, we are going to update the Web Portal Crossover Submissions to make it a little easier by reducing the amount of information that is required. This will be rolled out at the end of November and training will be in early December.


33. Can we attach the Primary EOB for commercial payers through the portal for processing? I know on previous webinars the attachment workflow was still in progress.

Yes, you can do this by scanning the EOB and just attaching it to your portal claim.


New FAQs added in response to Nov.  15 workshop


1. I’m registered in the portal, how can I see the fee schedule, if I’m not an administrator?

Currently, the fee schedule is only accessible by the administrator.


2. Am I able to submit any crossover claims with attachments at this time?

Yes, they can be submitted via paper or the portal.


3. Where on the claim do we enter the ICN for proof of timely filing (to correct a claim, not to retrieve the claim)?

This should be entered under “Search Claims”. Enter the claim number, claim ID, or TCN. You should submit that claim through paper and have it special-batched, showing why it is passed the one-year filing date.


4. Is there any way the timeout feature can be expanded in the portal? I do multiple claims but only 1-2 lines per claim. However, I’m being logged out after I enter about 2-3 claims, even if I am in the middle of entering a claim.

Currently, the portal is configured to time out after after 10 minutes of no activity/ movement. As a best practice, please monitor your activity time and ensure that the internet connection is stable, which can also impact submissions. You may also submit an email for further inquiry:


5. Are we going to discuss the submission of authorizations through the Kepro portal?

We are not going to discuss submission of PAs through any of the other vendor portals, only as it relates to MESA and the Gainwell system. All other questions should be directed to those vendors, independently.


6. We are a dental provider. Can you tell me if root canals require a prior authorization?

It ultimately depends on the place of service, but in most cases, yes.


7. How do you submit dental claims secondary to Medicare with the PR 96 denial from Medicare?

It would depend on why Medicare denied the claim. For example, if the claim denied because the service is not covered, then you would submit as a Medicaid primary with a copy of the EOMB. If the Medicare denies because the patient goes out of network, we would deny as well. It is also important to verify the member is eligible. Verify they are not enrolled as QMB only, or a Benefit Plan that does not cover dental. I would contact our Call Center and ask them to look at one of the claims to verify why the claim is denying.


8. Where do we find the Dental Prior Authorization?

Dental Prior Authorization (PA) information is reflected in the dental fee schedule and the OPPS fee schedule. Note that the procedure codes that only require PA in an outpatient hospital setting would be reflected on the OPPS fee schedule.


9. Where is the list of dental procedures that require a Prior Authorization?

Prior Authorization (PA) info is reflected in the Dental fee schedule and the OPPS fee schedule. Note that the procedure codes that only require PA in an outpatient hospital setting would be reflected on the OPPS fee schedule.


10. Eligibility Verification – a member is showing Medicaid State Plan – 075. Can you clarify what 075 indicates?

075 is the aid category of the member. This one is Parents and Caretakers of Minor Children.

Are Medicare/Medicaid crossover claims accepted on paper on the UB04, or does it need to be sent in the portal?

Yes, you can submit crossover on UB on paper.


11. What is the email address to the Help Desk?

The Provider Inquiry email address is


12. Can we please go over claim that has a TPL with a partial payment?

We will walk through those later this month. Please check the DOM homepage for our Webinar schedule.


13. Can you go over how to submit a crossover form in the web portal?

We are planning to walk through those claim types in December. Please check the DOM homepage ( for our webinar schedule.


14. On dental claims, can we add pre-op/post-op x-rays?

We will research this question further and provider more information in the future. Specifically, Code- D3330 does not have any pre/post-op configured in the system.


15. Can we please address the nonpayment of DME claims, specifically incontinence claims that have both T-Codes and A-Codes billed and date spanned.  We have been told in the past three webinars that this would be addressed in the next webinar.

Yes. We have said that. Please accept our apologies for the continued postponement, we are planning on walking through that claim type on Thursday. This is partly due to the technical difficulties we had last week. We are already putting the webinar content together, and DME claims will be on the agenda. If you can add any more details, I will see if we can incorporate that into the Thursday session. Thank you for your patience.


16. Does the eligibility not show the Medicare policy number?

Currently, this feature is not available. It is in the works to be updated.


17. When will the interactive fee schedule be up? The fee schedule just shown is by category.

For those looking for the Interactive Fee Schedule: currently, it is only available for those registered in the Web Portal (secure site). Go to “Resources” then “Search Fee Schedule”. The interactive Fee Schedule, Search Drug Code and OTC lists will be available on the public site at a future time. Please monitor the “Late Breaking News” and/or Provider Bulletins for additional information.


18. For prior authorization, I have been seeing a lot of the prices are not matching what Alliant has. It looks like the decimal has moved. Is this a known problem?

Yes, it has been. It has been corrected, going forward. If there are some specific ones that need to be corrected, they can be directed to the help desk:


19. We had a lot pushed out of Envision on the last date. These claims were filed timely but now past timely. What information is needed on a letter when mailing these papers as a batch?

You should submit that claims through paper and have them special-batched. Attached to the claims a copy of your documentation of why the claims should be reconsidered for denial and why it is passed the one-year filing date.


20. Are COBA claims going back through September 2022?

Yes, most have already been processed.


21. If I am logged in as a provider and I need to associate my trading partner, do I have to be an administrator in order for that feature to display?

Yes, that is correct.


22. I have had several crossover claims denied. Who can look into this?

Please contact the call center to examine why the claims are being denied.



New FAQs added in response to Nov. 10 workshop


 1.Where is the carrier code list located on website? 


2. What is COB?

COB is Coordination of Benefits; it’s the amount the provider receives from a member’s primary insurance.


3. How frequently is the “Late Breaking News” updated on the MESA website? It seems behind, compared to DOM.

The MESA portal seems to be a little delayed. Please check the DOM website for the most up-to-date news.


4. On the training courses it stated that the attachment could be in PDF, TIF, TIFF, GIF, JPG, JPEG,PNG and TXT. Is this information not accurate?

Attachments can only be received as a PDF.


5. Can I bypass the Medicare Advantage Plans carrier codes since they are currently unavailable?

No, the carrier code cannot be left blank. Please continue to check the late breaking news for updates on the Medicare carrier codes.


6. Where can the interactive fee schedule be found?

The interactive fee schedule is only available to administrators.


7, How do you update a termination date for other insurance information that would make Medicaid primary?

You can only report the insurance as terminated. It still would have to be verified, internally.


8. Where do I get the form to submit a paper claim? 

Paper forms have to be ordered, independently. Please refer to the billing guide on the DOM website for accurate form titles.


9. Did MESA process any crossover claims yet that were entered to MESA portal?

Yes, secondary claims are being submitted. If you are filing a dental Medicare part c claim, be sure to put 16 in the filing indicator line.


10. How do I address having several plans that have no group number?

If the member’s group ID was not captured from their identification card, there still needs to be something entered in the group number field (such as the member’s subscriber ID number). It cannot be left blank.


11. Why doesn’t the “other insurance detail for service line number” show up when you are putting in the service originally? We have to go back into the service line once its added.

This is just a part of the original design of the program. Considerations for enhancements are welcomed.


12. Should I wait on submitting Part C Crossover Claims until December, when system is updated?

You do not need to wait to submit crossover claims; however, t will be a little easier (less information required at the detail) once enhanced.


13. A fee schedule that I need is grayed out. What should I do?

If the Fee Schedule for your specialty is grayed out, it is because DOM is working on updating, and it should be available once they are done.


14. What is the email address for the Help Desk?

The Provider Inquiry Email address is


15. Where can I report TPL termination dates?

TPL Policy Updates


16. I am getting a denial when trying to void claims that were prior to MESA. It states “unable to process your adjustment request.” The claim type of the adjustment does not match the claim type of the original claim. How should I address this?

If you are trying to void or adjust a converted claim, we understand that there have been some errors. We are working to correct this in the system.


17. The claims I have used a prior authorization (PA) with have denied.  When is this going to be corrected?

Demonstrations on claims with PA will be forthcoming. In the meantime, please ensure that the prior authorization code is exact (capital letters, lowercase letters, etc.).


18. Are there any videos on the website on how to submit a Medicare crossover?

Not at this time; however, there is information the manuals, FAQs, and the posted webinars. Additional information is also available in the “Late Breaking News”. Generally, crossover claims are submitted similarly to any other claim, with changes to the filing indicator code and headers. Once the system is enhanced there will also be additional trainings.


19. Will the portal accept crossover EDI claims?

Please monitor the “Late Breaking News”. Updates for this process will be available shortly.


20. How do I void a claim that is inaccurately denied as a duplicate?

There are two ways this can be addressed:

1.) Enter the claim number in the search. Then, select and void one of them.

2.) Search the claim by the member’s ID or dates of service. Then identify the duplicate claims, select one and void it.


21. Medicare and Medicare Part C insurance are not on the carrier code list. Is it correct that we should put the insurance policy ID numbers on the claims?

You should use the carrier code that is showing up on the EOMB. If it is not there, use that for now. We are working on figuring out why they are not showing up on the EOMBs.


22. I am getting a denial when trying to void claims that were prior to MESA.  It states, “Unable to process your adjustment request”.  The claim type of the adjustment does not match the claim type of the original claim.  I am checking claim status and voiding that claim, so I’m not actually entering anything. 

If you are trying to avoid or adjust a claim that was converted over from the prior system, in some cases, it is not able to understand the claim and match it up. Most of the time it is due to the location that the prior system was using, which we have rolled up into a single location.  Typically, there is a mismatch that is causing the system not to recognize the prior claim.  We are trying to resolve this. There is not a work around in place right now. At this point, we will have to work through it and see how we can resolve those.


23. If we want to key in the claims in December, will they be denied for timely?

If they are Medicare crossover claims, then no because they have a six month from the date of the Medicare payment. Since we just started in October, then they should not have any issues.


24. Will all void claims show denials?



25. Please address the Medicare Replacement Plans and Advantage Plans carrier codes.  We need to be able to file our claims.  Can we put a dash or a zero or the Medicare ID# in the carrier code place, so we can bypass that and submit our claims?

Yes, go ahead and put your claims in. To get through that field on the portal, choose a value you want to use, but make sure it is all numeric.  For example, you can choose patient account or patient ID. Create your own dummy carrier code for all of those and put it in that field for now.


26. Will there be a reconsideration form that has the Gainwell logo on it? Currently, there is not one listed under the forms section on the DOM website.

That claim reconsideration form was done away with completely. There will not be a new one. Providers would just follow the process outlined in the billing manual regarding if you feel your claim was processed incorrectly. There was a published notice about this.


27. Did you say on a previous call that all authorization numbers have been loaded from Alliant?  If we have received denials on our inpatient claims (that were denied in October) for “INPATIENT PA NOT FOUND”, do we need to rebill these claims?

Yes, if you know that you have a prior authorization out there and you are putting the prior authorization on the claim and it got denied for no prior authorization found, then resubmit. We are seeing a lot of prior authorizations sent over with a lower case ‘a’ and not a capital letter ‘A’ as the starting point. That first letter has to be a capital ‘A’. So, if you submitted with a lower case ‘a’, then this is the reason.  We also had some issues with inpatient prior authorizations in October.  If you had a problem with those, please go ahead and submit those.


28. I have some claims that are denying for processing pair code invalid or missing taxonomy is not valid for performing provider.  I also have some claims that are paying for the same provider. I have not changed anything.  Should I resubmit?

Technically, no claim will ever be denied for the processing payer. That was shut off at the very beginning.  It will still show up on every claim as paid edit; not a denial edit. So, that is not a reason for the claim to deny. We have done some updates to the provider searches that took place recently. If you have claims that you submitted, the hit edits like the ones for taxonomies and stuff like that, you can go ahead and resubmit those. There are some resubmissions of half claims that denied for those reasons that are now being reprocessed by the department. You may want to wait until the next financial RA comes out and see where you are at first before doing any resubmissions.


29. My physicians are retiring, and the clinic is closing at the end of December.  I am running out of time on these claims.  I need to know how to get our Medicare Part C claims paid.  I just recently filed one through the system but it paid 10 percent of the co-insurance amount instead of the allowed amount.   The system will not let you put the allowed amount.  It calculates it to the co-insurance amount.  Plus, the carrier code list does not include the Part C carrier codes.  Please advise.

As far as the payment, the DOM policy for those is to only pay the amount of co-insurance, deductible, and co-pay that it is totaled on those. It does not pay the allowed amount necessarily. If you are only getting the co-insurance that you are reporting, that is the amount you are going to get paid based on DOM policy.


30. I have contacted Medicare, WellCare, Humana, etc. asking for their carrier codes, and they all told me they do not know what I’m talking about.  They are not listed on the EOB.  I really need these codes.  We have not been able to submit a Part C crossover in over a month not counting the ones that were denied out by Conduent with the conversion to Gainwell.  This is a huge issue.  Can I just use a dash (-) to bypass the carrier code requested on the portal until these can be provided to us?

It should not be denying the claim. Create your own dummy carrier code for all of those and put it in that field for now. You cannot use a dash. You can use a character and a dash or just put in Medicare or Medicare C within that code field, just to get past that field in order to get those claims submitted.


31. Are there any updates on how to submit TPL and crossovers in an RHC?

Any provider, including RHC, FQHC, and IHS should be able to submit claims with both TPL and Medicare on them.


32. Are the Medicare to Medicaid claims that are sent from Medicare fixed yet? Meaning, are they going to be fixed and paid or do we need to resubmit them?

Do not resubmit. We just started getting over those claims, and we have all of the backdated claims from September 23.  So, any claim sent from September 23 on that would have been normally sent directly to Medicaid has been sent. Those are processing this week. You should see them on your upcoming RA.


33. While going through the demo, we did not see an option for Medicare Part C; only Medicare Part A or B. Is there somewhere else we can see the Part C?

If doing a physician crossover, whether B or C, you are entering the information. It is just the claim filing code. If entering a B, you are doing a MB. If part C, you are choosing 16, which is Medicare HMO. Otherwise, you are treating it just like a regular crossover. You fill in the values that you are picking up from your EOMB from the payment information you got from that plan, Advantage Plan or Part B.  So, when you are thinking of Part C, the difference for us is that claim filing indicator. Everything else you fill out as you normally would any other Medicare crossover. On dental, it is the same way. You would choose indicator 16.


34. We have tried to submit paper claims for Part C, and they have all denied because of an error with the taxonomy. We have asked several times for someone to contact us to help with the issue and have not been contacted. Is there a way to have someone call us, or can we have a direct number to call someone to resolve this?

If it is completely wrong, meaning you have a DME provider and you are a dental provider, then that is one thing, and it needs to be fixed. But if you are using your taxonomy that you previously used with all of your payers, then you need to make sure it is the same within our system. You may have something different for Mississippi Medicaid than you do from your other payers. The taxonomy is what helps us find you in the system for the one-to-one match, and it is critical; so, you have to use the taxonomy that we have assigned you within the system. If you have reached out to us multiple times, please try us again, and let us get you connected with your Provider Representative.


35. Regarding institutional claims, do acute services and therapy services have to be split billed?

In terms of inpatient, acute care processing, we did not change anything from how they were billing from the prior system. You should not have to split out any charges straight to Medicaid.


36. What are the requirements or rules for timely filing?

You have up to one year to file any claim into MESA from the first date of service. If it is a Medicare crossover, then you have up to six months from the Medicare paid date to be able to submit those claims. In the case of the Medicare crossovers for the last month and a half, you will receive a Medicare pay date within the last month and a half, and you will have up to six months.


37. For the voids that cannot be voided, has Mississippi Medicaid been notified? I am asking because they do a six-month audit, and these will still show on open credits for those providers. Should providers issue paper refunds for those that will not void? And if yes, what information should they submit and where for correct processing?

We know about the issue, and we are looking into it. It is not an easy solution, yet the team is looking into it. We may need to look at these on a case-by-case basis.


38. We are part of a group and have to have the rendering provider information. I can see the provider as affiliated, but the claim denied stating “provider is not enrolled under billing group number”. Is there something providers should have done to enroll as existing providers to the Group ID?

If you have a group with a single location or multiple locations, the rendering providers for each of those locations were also converted. So, whether it is a group with one location or 20 rendering providers associated to that group, we converted those rendering providers over. If you have selected a location for a rendering provider that has always been associated to that group’s location, yet it is now being denied, then there might be an issue with how we converted it, and you should contact the call center.


39. What about denied claims for provider taxonomy but some claims are being paid for this same provider?

We recommend contacting the Call Center. We have updated our system since go-live.  So, if some claims are going through now and the ones in October did not, then I would re-submit those earlier claims.


40. Conduent required that the payment and contractual be bundled and reported as just a payment amount on the electronic Medicaid secondary claims to commercial primary.  Do you require this as well, or do you want the payment and contractual reported separately on the electronic claim?

I am guessing that this would be an EDI claim, not portal. If you are submitting an 837, refer to the companion guide and how it requires the COB loops to be completed.


41. Can we still mail in claims with the HCFA and EOB attached?

We take paper claims. We take the CMS 1500, UBO4, ADA, Pharmacy, and Universal NCPDP forms. We take paper crossover claims, which you have to include the Medicare EOMB.


42. Are you saying that all EDI Crossover claims will need an attachment?

Yes. If you submit a batch of EDI Crossover Medicare/Medicaid claims, you will have to submit a copy of the EOMB. The process for how to match up this paper claim with your electronic claim is currently being worked out and will be rolled out to you all within the “Late Breaking News” soon.  You must make sure that you are following the EDI guides that we are updating as well to provide more information. If you are submitting a claim that requires an attachment, you assign an attachment control number and put in the PWK segment.  When you do that, it will suspend for 21 days, and it will be awaiting you to mail in the paper attachment. Then when we receive the paper attachment, we will match it with the electronic claim, and the claim will continue processing.  However, if you send an electronic claim that requires an attachment, and you do not enter the PWK segment that claim gets turned into an electronic claim with no attachment and the claim will deny.


43. Did MESA processor process any crossover claims yet that were entered to MESA portal?

Crossover claims that are coming through the portal are getting processed. The only ones being held were the COBA Crossover claims, which we have started processing now and there is a backlog of those.


44, We have some claims that Medicare automatically transmits to Medicaid.  We have not received any payments to our clinics.  When can we expect these payments to show up or do we need to submit them directly to you?

These are the COBA file, and we have started processing these claims. There is a backlog. Start monitoring next week’s RA and see what shows up next week.


45. The last EOB from Envision denied all the crossovers for Part C they had on file.  Do we have to re-do them? Are you saying we can see those claims in Gainwell and fix some number to make pay? When I called, they said we had to resubmit.

If the claim is denied in the prior system, then we are going to convert that as a denied claim in the current system. So, yes, you would need to re-submit that claim. Also, keep in mind that within MESA, the Part C claims are being treated as crossover claims.


New FAQs added in response to Nov. 8 workshop


1.What do the different numbers mean after the Medicaid State Plan? We are dental and see different numbers after, and sometimes it will tell their exam date and other times it will not.

The last 3 numbers after the plan description is the category of eligibility. When you see ‘TXIX’ under the Coverage, then that means they are in the traditional Medicaid 19 plan.  A lot of members within Medicaid will have a pharmacy benefit plan as well.  The ‘019’ is part of what triggers the member to be in one of the pharmacy plans.


2. Can we only check eligibility for the past year?

You can only go back a year, but you can only view 30 days at a time.


3. Can you please advise if individual providers will also need their own portals?

Every provider has to be registered and have their own login. They can be added as a delegate but they still have to be registered and have their own login.


4. Will the benefit details show if they are active in the additional Medicaid plans (UHC, Molina and Envolve)?

So, what you are seeing in the tracking for benefit limits is for straight, traditional Medicaid (aka fee-for-service) plans. The benefit limits is just for traditional Medicaid processing.  It does not show the limits for the other plans, such as UHC, Molina, etc.  Additionally, the code for eligibility with descriptions are located in the provider billing handbook as well as 270271 companion guides, which are on the website.


5. Will this show if the patient has retro Medicaid and their add date for this?

To see retro, go to the home page. Then, scroll to the bottom under ‘Provider Services’ on the left side. Select ‘Member Focused Viewing’.  Select ‘Search’ and enter the member ID number. Then, select ‘Search’.  Select the hyperlink for the member. Under ‘Coverage Details’ on the right side, it will list the retro coverage.


6. With retro, is it still based off of the add date?



7. Do we have any guidance on how to submit Rural Health secondary claims on the portal?

We are enhancing our web portal crossover claim submission to not make it require as much detail because for many of those claim types (physician, outpatient, etc.) we required information at detail. There was a lot of data being captured that was not necessary and it made it more cumbersome for providers.  You will see information going out today within the “Late Breaking News” in regards to crossovers.  There will be a webinar just on crossovers within the future.


8. Will there be a secondary dental claims demonstration?

The Claims Submission webinar will be on Thursday, November 8, 2022.  Additionally, if you are a dental provider, and you are billing for a member in Medicare Part C Advantage Plan make sure when you are creating the dental claim that you are putting the filing indicator code of ’16’.


9. When are we going to be provided the carrier codes for the Medicare Replacement Plans and Traditional Medicare? The carrier codes listed under Resources>Links are Commercial Insurance, not the Advantage Plans. The carrier codes are not listed on the Medicare Replacement Plan EOB like it was suggested.  We cannot file Part C Crossovers through the web portal without these carrier codes. 

Carrier codes have always been on the Medicare EOBs, but we have heard that they are not currently showing.  We are looking into this, so monitor the “Late Breaking News”.  If we are able to get a comprehensive list, then we will put that out there.


10. How can they ensure that providers are also being enrolled in MSCAN and CHIP plans for UHC and Molina?

When enrolling, the provider would specify which plans they would want to enroll within. At the time of application submission, they can select MSCAN or CHIP depending on which plan they would want to enroll into. This would only ensure that the providers are enrolled in those programs but that does not verify that the providers are contracted with the CCOs for those plans. So, the next step that the provider would have to do is work with the CCOs to set up a contract after they are enrolled successfully in Medicaid.  Once a provider contracts with the CCOs, we do receive information from the CCOs that we capture on the provider’s file that tells us for the duration that the provider is contracted.


11. Are the effective dates for MSCAN and CHIP plans the same as their effective date for State Medicaid?

The provider can request an effective date on the application, but that is something that will be reviewed by DOM and Gainwell analysts to see if that is the effective date that should be assigned to the provider. Once that date is identified, that would be the same date assigned to all 3 programs, if the provider is enrolled in all 3 programs.


12. Do we always answer “no” to the “were you ‘previously enrolled” question since this is a new location for an existing provider?

If already enrolled in the system, make sure you give us that information as it tells us that you were previously enrolled.  For new applications previously enrolled, no.  So, only mark “Yes” if it is a provider coming back to the same location.


13. I have noticed that some of the other insurance provided has termed. However, I do not see anywhere to note that information.

If talking about CPA other insurance, we do not reach out to other insurance.  You can add it and delete it.  To delete insurance, you have to delete at claim level.  To add other insurance: click the ‘Eligibility’ tab, enter the member ID, click ‘Submit’, select the ‘Other Insurance Detail Information’ hyperlink under ‘Coverage’ at the bottom of the page. Then select ‘Add’ at bottom of the screen.


14. So what did centralized credentialing do for us if it is still required to apply with each CCO?

The benefit of centralized credentialing is that prior to Mississippi Medicaid implementing this credentialing functionality, when the provider chose to contract with the CCOs, all of these CCOs would credential these providers individually. With centralized credentialing moving forward, if a provider is enrolling in MSCAN and CHIP and the provider is not contracted with a credentialing agency, a contracted vendor will perform the credentialing. Anything outside the Medicaid line of business, CCOs will still continue to credential the provider.  With the Medicaid line of business, it is DOM that will be doing the credentialing and CCOs will not have to redo the credentialing for that particular provider. It is saving the credentialing effort that a provider would have to take with each CCO that they used to do previously.


15. Why do so many of the same insurances pop up?

This is a glitch that is being worked on currently.


16. The CCOs keep telling one of our providers that MESA will be enrolling the providers in the managed care contract plan with DOM. Is there someone’s contact information we can provide them to help get them get on the same page so they do not delay our enrollment requests further?

The main process of providers enrolling into the manager care programs is the credentialing aspect of it, which is why this enrollment is taking longer.  This is currently being worked on. The help desk information, the email, and phone numbers were shared with providers. We encourage you to forward your questions through one of these contact options. When there are managed care programs on the application, the credentialing may take longer, which is why the applications are taking longer to get adjudicated.


17. Should the CCOs honor the DOM effective date?

Yes, the CCOs will honor the DOM effective date.


18. You stated this centralized credentialing is used to enroll both traditional Medicaid and the CCO plans but you also stated we need to contract with the CCOs in addition to enrolling with DOM. Please explain.

If a provider is enrolling in fee-for-service only, the provider will not be subject to centralized credentialing.  However, if the provider is enrolling in managed care programs only, such as MSCAN and CHIP, then that is the only time the provider will be subject to centralized credentialing. The provider will need to enroll in those programs prior to working with the CCOs to start providing those services.  So, the provider will have to first be enrolled in DOM and pass the credentialing and all other enrollment requirements to get enrolled in the program.  Once the provider is enrolled, they will have to work with the CCOs to contract with them.


19. Will the enrollment application tracking number (ATN) only be available in the portal?

No, the ATN will also be sent via email.


20. Please go over how the “copy” works under enrollment.

This functionality would only work for the submitted applications.


21. Can I use the copy feature to enroll a similar provider? (For example, can I enroll a nurse practitioner and then “copy” the enrollment and change the demographics to an additional nurse practitioner?).

Yes, you should be able to utilize the copy feature in this manner, but please ensure that you have reviewed the prepopulated information thoroughly and update it for the accuracy of each new application.


22. The taxonomy page is grayed out. I’ve tried to use Firefox and Google, and it’s grayed-out on both pages. Several others in the office have gotten the same thing.

This seems to be an internal office issue. You would need to go back through your IT for settings; maybe a firewall has been set up.


23. Where does the claim indicator “16” go on hard copy claims for Part C ?

This is only if doing on the portal electronically. For paper claims, you do not need to put that indicators on the paper claims.


24. Is there anything specific that we need to put on the Part C claims to show they are Part C?

We will go over claims questions on Thursday’s webinar.


25. Dental secondaries, any specific number (like 16) for crossover claims… Do private/commercial with Secondary Medicaid need to add a specific number to have them processed correctly?

This shouldn’t be different as you were doing it prior. The only difference is Dental Part C needs filing indicator code 16. You fill them out as you did previously.  Crossover claims questions be discussed in Thursday’s, November 10, 2022, webinar.


26. Will Medicare Part C be covered on Thursday?

No, we will host a separate seminar devoted to Part C at a later time. Please monitor the “Late Breaking News” for continual updates to this process. As a reminder, Part C is completed similarly to Part B crossover.


27. I have a clearinghouse as my trading partner (not myself). Is there a way I can directly access ERA 835 files?

The only entities to receive 835 files would be the trading partners. To acquire access, the trading partners would need to link the provider ID via the trading partner’s reference tab in the portal. The trading partner would then have access to the files via the portal and be able to share the information.


28. I previously registered my provider profile and trading partner profile separately (although I fulfill both roles). Is there a way I can combine them both under one account?

Unfortunately, once a trading partner profile is created, it cannot be linked to an existing provider profile and there is currently no way to delete it. You will have to toggle between the two profiles that already exist.


29. I bill as a group. Should the trading partner ID be added to each individual provider’s registration or only to the group enrollment?

If you only bill under a group, it should be acceptable to only add the trading partner ID to the group enrollment. However, be advised that the information will not be automatically linked under the other accounts. You will only have access to the trading partner information through the group profile.


30. My assigned taxonomy is inaccurate. How will this be addressed?

There are two parts to this answer:

1.) If the taxonomy is simply not as specific to your field of service, it is best to use the assigned taxonomy, as more specific taxonomies are being added frequently.

2.) If the taxonomy is completely wrong and unrelated to your field of service, please address your concerns to the provider enrollment fax number, found in the portal, to have your taxonomy reassigned.


 New FAQs added in response to Nov. 3 workshop

1. How do you determine the difference between each Medicaid state plan?

This is only for MS Medicaid. If they are only fee-for-service, it will be evident in their file. If you expand the file and they have a managed care plan (such as MSCHIP/ MSCAN), those details will be there as well.


2. The Part C crossover claims I have submitted electronically have been denied for no EOB. I verified that primary payment was submitted on the charge level and went out on the electronic file. Is there an issue with submitting these electronic?

Updates are being made daily to make the web portal more user-friendly and support the processing of crossover claims. We recently received updates for COBA files, so that process should be more efficient. However, if you submit a claim EDI/batch process without the PWK segment or attachments, it will be automatically denied. Please continue to check the DOM website for updates on this process.


3. Where can Late Breaking News be located on the DOM website?

Late Breaking News can be found on the DOM homepage under “Provider Portal”. It can also be found on the provider portal homepage under “Latest News”.


4. How do you know if a member has dual eligibility?

To be reviewed in a future workshop.


5. As a DME Provider, how should I enter Part C Medicare Advantage claim?

It should be entered as a crossover professional claim with a filing indicator (first page) and set at 16. Complete it just as you would a DME claim on Part B.


6. Does the login information from Medicaid Envision transfer to MESA?

No, a new registration and profile will have to be created, using your Medicaid ID number and the last four digits of your social security number (or tax ID number).

7. What is Fee-f0r-Service?

This is the traditional Medicaid program–not members enrolled in managed care programs. It is also known as Medicaid Primary.


8. In the portal, does the QMB provide the Medicare policy number and managed care plans (if applicable)?

Currently, this information is not available, but it will be a forthcoming enhancement to the system.


9. When conducting an eligibility check, does the system identify inactive status?

No, there will be no coverage details provided. It will be blank.


10. How do I determine the effective dates for managed care plans?

There is no effective date for managed care plans. The effective date depends on their Medicaid state plan coverage, and the search criteria will display if they were enrolled in a managed care plan for the dates of the search.


11. What is Title 19 (TXIX)?

Please refer to the Mississippi Division of Medicaid homepage, for specific definitions and rules, as they apply to the state of Mississippi.


12. My taxonomy is not as specific to the services that I provide. Can I use a different one?

This is a taxonomy-based system, for efficiency purposes, it is best to use the taxonomy that you have been assigned. We are working to add more specific taxonomies, however in the meantime using your given taxonomy is the best practice.


13. What should be in the PWK segment?

If submitting an attachment, fill out section O2 with BM (by mail). In section O6, enter an ACN (attachment control number). The ACN must also be on the attachment when sending to Medicaid, so they can be linked. You have 21 days to submit the attachment to Medicaid. Once done, that will allow the claim to adjudicate. The process of submitting attachments is still being revised. Please monitor the Late Breaking News for updates and step-by-step instructions.


14. Can I edit a claim and add an attachment, while it’s in suspense?

No, once it is in suspense, the claim cannot be adjusted.


15. As a DME provider, is there a work-around for billing prescriptions more than once per 30 days?

In general, the best practice is to complete the prior authorization process in order to bill additional claims. For more specific matters, please contact the call center for personal assistance.


16. Is there a list of denial codes available?

Further research is needed.


17. What should I do if I have a claim that is inaccurately being denied as a duplicate?

A call center representative can assist with this matter. The representative can review the related history of the claim and identify any conflicts.


18. How can I verify a provider’s taxonomy?

Go to the DOM website. Go to FAQs MESA. Click Provider ID Search Tool. Enter provider ID and type (NPI, Legacy, etc.). The results will populate for verification.


19. How can we see that rendering providers in our group have the correct taxonomy code in your system?

Click the FAQs blue box on website. Click the Provider ID Search Tool blue box. Choose a selection from the drop-down list within the “Search Provider” box on the left side. Choose a selection from the drop-down list within the “Provider ID” box on the left side. Then, click the “Search” button. Scroll to the bottom and the assigned taxonomy is listed for the provider. This also lists the mail location, physical location, and other variables for the provider. **Note: We are trying to make this a bullet point on the homepage, so you do not have to go through FAQs to find this information.


20. Before Gainwell took over if the patient had Medicare Advantage primary and Medicaid secondary as long as the primary payment amount was not $0, we could send those electronically. Now they are denying all of those sent electronically stating that an EOB is needed. The primary EOB information is sent in the electronic file.

When we process Part C’s as crossovers, they follow the crossover policy, which is that we are requiring the EOB. We are working on the process to submit the EOB attachments. Since we are working on where the attachments are mailed and how they get matched up with their electronic claim, we are processing Part C’s as crossovers within the system and because of that, they are following the same crossover policy in terms of requiring the EOB. You can send the EOB on paper. To do this, you would fill out the paper claim form and submit it along with the Medicare EOB (A, B, or C). However, COBA files are going to start processing directly from Medicare soon for the Medicare EOB A and B. Medicare C will still require those to be submitted through either the portal or by paper. The portal is going to be enhanced soon.


21. When filing claims such as Rural Health Clinic (RHC) on a crossover, would those need to be keyed as a UB or professional claim? Medicare requires it to be a UB.

* Per the call, Jenni said that we need to distinguish RHCs, FQACs, hospital based and/or the claim forms that we accept.


22. We have to include the billing provider/performing provider on our claims or they will deny the billing provider group. The performing provider individual taxonomy codes are different.

Correct. You could have a group such as a multi-specialty group that has a taxonomy, but the individual renderings will have a taxonomy that might be more specific to them as an individual and their scope of services they perform. So, it is true that your billing as the group could have one taxonomy and your renderings will likely have something more specific to them individually for those individual performers. This is why using the tool that we reviewed on the November 3, 2022, webinar to look everyone up will tell you exactly who has been assigned to what taxonomy.


23. I have a patient who has a commercial/group policy policy and Medicare secondary, how do we file a crossover claim? We have never had a commercial insurance crossover.

This will be discussed within the Provider Webinar next week.


24. We’d like a request for claim demo. 

The claim demo will be during the Provider Webinar next Thursday, which will give us time to have our updates in for the crossovers and make sure that we are showing the most current filing process on the web portal.


25. Do we file the Medicare replacement claims using paper?
For the Medicare Advantage Part C claims, paper is an option.


26. We have thousands of claims that have been rejected since we changed over to MESA that previously went through. Why is this happening?

This is hard to answer because there are many reasons for denial. It would depend on the error code. It could be that they are being submitted electronically because we changed SNIP levels, which does require providers to update the submission of batch claims. We need more specifics, such as, are they getting rejected or are they getting denied.


27. If a member has Medicare but it does not show it under other insurance, can the provider add it or how does it get added, if not?

Medicare additions come directly to us from Medicare, so all of those get submitted directly for Medicare to us, based on the member information. You can still submit the claim, but you cannot add the Medicare information through the portal.


28. Our ER group has many claim denials for group taxonomy and rendering provider taxonomy issues. Currently, only the admin user has access to view the rendering provider taxonomy on the MESA portal; delegates do not. Will delegates have the option to have future access to view the individual provider taxonomy on the portal? This is a section on the portal titled “Affiliated Providers”.

The delegate will not have access to that. It is only going to be the admin since they are the ones that add it.


29. Where do we need to go to verify a managed care plan for a member?

To access, select the “Eligibility” tab within the Provider Portal. Enter the Member ID. Select the “Submit” button at the bottom. Click the “Medicaid State Plan” that populates at the bottom of the page under the “Coverage” column. Then, this will bring up the panel that shows member care assignment details. It will show what managed care plan they are in and who they are associated with, such as United, Magnolia, etc.


30. Do we have to submit all secondary claims with an attachment? Previously, we were able to send some of our secondary claims through our clearinghouse if we received a payment from the primary payer and the claims would reprocess. Now, we are receiving a denial for all of our secondary claims for missing an attachment.

All of your secondary claims for Medicare do require the EOMB regardless. If you are talking about other insurance, like private insurance, those do not require a secondary or an EOMB.


31. Where do we find 02 and 06 segment? Is this on claim form or on portal claim?

That is not on the portal claim or paper claim. That is only on the EDI transmission submission. If sending in paper, you automatically send the EOMB in with it. If sending in portal, you will be downloading the EOMB through the attachment section. Within the portal, there is a section that says attachments, add attachments, and you click add. This will give a drop-down to describe the attachments you are adding. Then, you upload your attachment. Then, submit. There is nothing on the portal that specifically says pwk. That is terminology for your EDI.


32. On Tuesday, Curt told us that Medicare carrier codes are on the Medicare EOB, but we have not seen this code on our Medicare remit. Can someone help us with this?

Since the EOMB is a little bit different for each one of those, you would have to get together with your Provider representative. It is not something we could do during this meeting.


33. Providers need written direction on Medicare A, B, and C primary claims.

Linda Cramer will take this back to the trainers, and we will create something for the providers to use and put it out there. Jenni said that we are trying to make the way crossover claims are entered into the portal a little more user-friendly.


34. My agency submits 837 P batch files for crossovers. How will the attachment process affect us? In the legacy process, the required EOB information was included in the file. Will there be a different process for this?

Curt covered this earlier with the pwk information. We will have more communication out there once we have finalized our process for submitting attachments for the electronic claims. This will go out under the “Late Breaking News”.


35. Do we have any kind of process yet on how to handle the unpaid claims carried over from the previous system?

Everything that had already been processed has been converted. There were lots of paper claims that were sent to us, and we have been working through those. We had some batch that were in hold and were released early on and have been processed. We may have some paper claims that are still in flight but in terms of electronic and everything else, we brought everything over. So, if you still have claims that you submitted prior to the new system go live and you have not seen them in the system, we would have processed those to date, if submitted electronically. If they are paper, I do not know what day they are scanning right now, so we would need to check on that. All claims submitted were finalized in the Conduent system prior to us taking over.


36. I have my delegates set up to have all functions except claims. However, they do not have the ability to check eligibility. This is one of their primary jobs. Is this something being worked on?

A delegate can search to verify eligibility. Click “Manage Accounts” on the home page once the provider is logged in to the system. Click on the “Search Delegates” tab. Choose the delegate from the list of names. At the bottom of the page under “Functions”, it will show “Verify Eligibility”. Verify that the delegate’s “Verify Eligibility” box is checked.


37. We have a high volume of institutional crossover claims and it would be impossible for them to key each and every claim. So, we will have to submit some of our claims paper. The paper billing provider manual provides some details on the format of the claim. Will there be a training session on submitting paper claims, and what is required on the claim? Some of the information provided in the paper billing manual is not clear on fields that it states required information should be listed.

We are encouraging electronic billing, so we will have to consider this suggestion. The paper billing manual has pictures of every single field with a lot of details. We want the paper billing guide to have clear step-by-step instructions and not be too cumbersome to go through. If something is unclear there, then we need to clear it up. So, we can work with the operations team to figure out where we need to enhance. Curt said if there are a lot of claims, then he is assuming this is a large hospital and many of these claims will probably come over from COBA. Jenni suggested in this situation if I were a large hospital where most of my claims typically come over from Medicare without incident, then I would not start doing a bunch of paper claims yet. She suggested to wait for the COBA files to funnel through within the next few weeks.


38. I have unpaid crossover claims carried over from Envision. I need to know if all these claims can be accepted with our OLD taxonomy code. If not, we will have to demand over a 1,000 new claim forms.  Is black ink acceptable?  

Black ink is acceptable. The only ink not accepted is red. You should be submit the CMS 1500 or UVO 4. We will not accept the old self-made claim forms in the old system. For the taxonomy, if they were denied in the old system, then they would have to be resubmitted. If paid in the old system, then no resubmission is required. We need more information regarding these claims. Need email address for Cathy Parrish. You may file with the old taxonomy code. If we can find the one based on that information, then there should not be a problem. If there is a problem, then those claims will get denied for improper provider. So, go ahead and resubmit as they are.


39. We are a rural health clinic and due to the Medicare rate, the payment will always be more than the charge. The HMO EOB will never balance. How should we file those?

You will file those with your current billing rate and if the Medicare rate is over, then that will be set to where we can look at it and make the right payment based on the different rates. We know RHCs and QHCs have certain rates for an encounter, so those are taken into account.


40. Conduent denied all pending parts crossover claims on September 26 for the changeover. How are those denied claims going to be handled?

The Provider would need to resubmit with the correct taxonomy.


41. Do the denied claims from Envision need to be corrective claims in MESA?

If they were denied and brought over as denied, then they would need to be re-submitted.


42. Is the 0AJH payor ID still valid for Part C crossover electronic claims? If not, what payor ID should we use for these electronic claims?

That would still be a good payor ID, if that is what they were originally using.


43. My crossover claim is changing from crossover professional to professional causing my claims to deny for-patient if eligible for Part C. I even printed the claim detail before submitting, and it says crossover professional at the top but changes when the claim is submitted. Any answers to why this is happening?

I assume this was a paper claim that was submitted. When we are scanning and batching the paper claims, we are not catching that they have checked that they are Medicare. They may not have information on the face of the claim to suggest they are Medicare, so we are batching them as physician claim with an attachment. Re-submit the claim for it to be processed as a crossover.


44. We submitted a claim on the portal with Cigna (commercial) EOB. The claim denied stating patient has commercial insurance but when I checked on MESA eligibility, it shows the Cigna Plan that I submitted the EOB on. Why did I get this denial, and what do we need to do?

We have some claims coming in as primary insurance as primary and Medicaid as secondary. The private insurance has applied all of their paid amount to the deductible, so zero private payment is showing, but all amounts are going to the deductible. We may have a potential issue here. However, if you have a prior payment, and we have captured that payment then you should not be getting the denial. We suggest looking at your claim and see if it all has been applied to the deductible.


45. When I correct a claim on the portal for outpatient, would I need to use type of bill 131 or 137?

When submitting the 137 (technically, if you are trying to void that would be a 138), make sure your original claim was an outpatient claim and that you are not trying to submit a void for the non-essential part of an in-patient stay. Make sure the first claim was not considered an 11 X or something like that.


46. What box on the CMS 1500 are you looking for the claim indicator?

The CMS 1500 is automatically listed as a professional claim. If it has Medicare crossover information, then it would be listed as professional crossover.


47. How will we see all claims from Conduent that was previously processed? Will you accept the Conduent TCN?

We do accept the Conduent TCN for adjustments or voids. If submitted by you and you have the rights to see them, you can see them by the member and dates of service. They will show up in the system with a Gainwell ICN starting with a 4. You can also search on the Portal by TCN with a claim ID. There is a box for this.


48. Crossover claim keyed denies with “CALCULATED DETAIL MEDICARE ALLOWED AMOUNT IS ZERO”.

Any outpatient or professional or dental Part C claims coming in are required to have the Medicare information listed for each detail. The detail information should be listed on the EOMBs for those as well because Medicaid started doing that back in 2015.


New FAQs added in response to Nov. 1 workshop


1. Is the MESA ID required on the claim or only the NPI and taxonomy?

Only the NPI and taxonomy are required on the claim; not the MESA ID.


2. What do we do when our assigned taxonomy is wrong? For example, we have an internal medicine physician who has been assigned dermatology as the taxonomy.  This is not the type of medicine he practices.

On the DOM website, there is information where you can contact various different entities.  Find the provider enrollment fax number and send in a letter on your letterhead stating that the taxonomy assigned is incorrect, list what the taxonomy assigned should be for this provider, provide the NPI, provide any further information needed, and provide a contact name with contact information. The enrollment team will coordinate the approval process with the Division of Medicaid.


3. Are we going to be paid for Medicare to Medicaid crossover claims any time soon?

We are working on this as fast as we can. All entities involved have made this a top priority, including Medicare.  There is not an ETA at this time.


4. How can we submit our more specific taxonomy to be added in the future or if they already have it due to it being on our crossover claims?

As a Provider, you do not need to do anything. We are aware of all of the taxonomies out there and we can see them on the claims.  You can also let your Provider Association know what things you would like to see in the new system, such as taxonomies.


5. What field does the taxonomy number go in on the CMS 1500? What loop is filing electronic?

1) For the CMS 1500, if you are a group putting something at the performing/detail level, that is in 24 J in the gray area. If you go to the billing manuals on the DOM side, it has screen shots/pictures of the 1500 which shows you where to put your taxonomy. You will put your NPI at the detail and within the gray area above that, you will put your taxonomy. Then, at the billing down in 33, you will see an ‘A’ for NPI and a ‘B’ for your taxonomy.

2) On the electronic claim, I do not have an answer. I am sure a team member can have it by the end of the call and post it on the chat.


6. On the most recent RA, I had a Medicare crossover claim that processed and denied due to taxonomy, so maybe they are starting to trickle through the process?

No, that would probably be something that came in on paper, through the portal, or a batch transaction. We have not processed a COBA file to date.


7. We are receiving denials for group billing providers not allowed for claim type. We never had this issue before our taxonomies changed or were updated to a higher level.  Why are we getting this type of denial now?

If you are billing through portal for your individual, we ask that you leave the rendering and facility fields blank. Then, those will process for the individual just fine.  If you are a group and need to have the individual rendering, then you will need to enter something in the rendering field. For the individual, there is a drop-down list for the provider to choose the correct location at the top of the portal where you see the provider’s NPI.


8. Is ‘Critical Access’ not an approved taxonomy anymore?

This may be that we do not have that level of specificity, which means we rolled it up into the higher basic, acute care. We are looking into this, but the higher-level taxonomy does not impact your payment structure for Medicaid.


9. I am with Life Help, a Community Mental Health Center. We had a couple of claim payments that were deducted for the co-pay and co-pays do not apply for our services.

In the prior system, there was an alpha character that you would append to the ID to tell it to bypass the code. The system relied solely on that alpha character. In this system, a combination of things are used to validate. For example, we can validate if they are in a long-term care facility, their age, if they are pregnant, or whatever co-pays are created. So, we use whatever is in the system to validate because we do not want those alpha characters on the claims anymore. If it is a service that should bypass co-pay and you see it still happening, then we will need to know about this. The provider will need to provide us with the submitting taxonomy code, the procedure code, any modifiers, and a statement that you believe it should be bypassing co-pay.


10. Once Medicaid starts processing COBA files for Medicare, will you go back and process all remits since MESA went live?

We will go back to the original date that Medicare stopped working with Conduent. We are requesting to get all of those back files, so we can process those. We will also look at the timely filing of those when they come through because we understand that the timely filing affected those.


11. If Medicare processed primary claims under our old taxonomy code, will Medicaid reject those once they start processing?

Our goal is to not reject those claims based on taxonomy. We are trying to put some enhancements in to find that unique match using various criteria on that claim in a way that allows us to verify who you are and the taxonomy code in the system and to not start rejecting out a bunch of crossover claims.  We have put in some things that are going to make this better and the team continues to look at the data.


12. Can you provide the Provider Services fax number?

It is 1-866-644-6148.


13. Our Medicare taxonomy codes will be different than the new ones assigned by Gainwell.  Will those claims be denied?

Our goal is for them not to be denied.  When the claims crossover from Medicare (COBA files), our goal is always not to be denied.  We are working diligently to find ways to take what is on that crossover claim and find your Provider (that one-to-one match) and find you in our system and allow the system to utilize that taxonomy we have in the system.  The ultimate goal for a taxonomy-based system is to be able to utilize what you are submitting on the claim as your taxonomy.


14. Will the time refiling deadlines be extended due to all of the issues we are having?

In general, no, they will not be waved.  For Medicare crossover claims because of the backlog that we would be processing, this is something that we will be considering.


15. Where on the claim will the taxonomy be?

If you go to the Provider Billing Manuals on the MS Division of Medicaid website, the paper claims billing manual will give you this information for the paper claims. If you are doing a web portal claim, a field is provided.  If you are doing an 837 claim, the companion guide will tell you where the taxonomies go.


16. Do providers still have a year to file claims?

In general, yes.  For any caveats, look in the billing manual.


17. To be paid at this time, do providers have to manually do crossovers?

Yes. If your business does not have massive amounts of crossovers, then we recommend that you go ahead and get those submitted either by paper or portal.  If the vast majority of your rendered services are Medicare and Medicaid, then you might want to let us work through the process with Medicare and get those back log of files processed.


18. Why are we using taxonomy codes? Since there are so many taxonomy codes, why not just use the NPIs and TIMs?

The state wants us to be a taxonomy driven system. Your NPI alone does not always give us a one-to-one match in the system.  In addition, policy can be configured around taxonomy better than a provider type and specialty in many ways.


19. Can you show us where to find the companion guides?

Click on the MESA Portal for Providers. Scroll down the page and find the ‘Additional MESA Portal Resources’ in blue font. Click the ‘­EDI Claims Companion Guides’.


20. Do the taxonomy codes need to match CMS 33 B and 24 J?

If they mean they are billing for themselves on a physician claim, then those two taxonomies should match. If they are billing for a physician group and an individual, then those don’t necessarily have to match.  To clarify, if you are a physician group, then you put your group’s taxonomy in 33. Then, in 24J, you put the taxonomy for the doctor who is a part of your group.


21. Is there a list of approved taxonomy codes?

It is on the checklist on the enrollment form. It is also on the portal: enter through the Provider Login. Click ‘Provider Enrollment Access’ link on the left. Click ‘Enrollment Application’ on the left. Scroll to the bottom of the page and click ‘Continue’. Select ‘Click Here’ for the application type that you need.


22. How can Gainwell assign or change a Provider’s taxonomy code when the provider has it linked to the NPI when they registered on the National Plan and Enumeration System, which was thought that all Medicare, Medicaid, or other insurance carriers have to abide by?

Technically, that is incorrect. NPBS only sets up the taxonomy for you as per what you believe is your taxonomy at the time that you set up NPBS. The NPI and taxonomy can be used differently for all different providers or payers.  Technically, we can assign you a taxonomy that we believe you were registering for or were registered for at the time.  We do double-check those when we do a first initial enrollment against MPES to see if the taxonomies do at least come into the same category, but they do not necessarily have to match.  So, you can change your taxonomy based on what payor you are going to. The only thing you cannot change is your NPI.


23. When a delegate leaves the practice, can they be deleted or are they there forever within the portal?

You can go in under that administrator and look for that person who is no longer employed and you would inactivate them, which does not allow them to get back into the provider portal.


24. Does the administrator need to setup as a delegate?

No, it is not necessary, but it is helpful if there are multiple groups. An administrator setup as a delegate can link multiple users together and make selections between providers within the groups.


25. What if I am receiving a 504 Forbidden error message when I try to access the portal?

This is likely due to an internal issue, such as a firewall in place. This can mostly be addressed by contacting your company’s IT department.


26. Can a delegate or staff member access the affiliate provider link?

No, only an administrator can access the affiliate provider link and there can only be one administrator per account.


27. What does it mean if my security question responses are invalid?

This likely means that there is a typo or some other error in the response, such as capitalization, missing or added number or other character. Please double-check your responses. Also, ensure that your user ID is correct. This can be verified by contacting the call center. If the issue continues, return to the home screen, enter your user ID and you will receive a challenge question for further authentication.

28. Does each provider in a group have to create their own account?



29. What happens if a staff member doesn’t have a driver’s license?

Enter 1234.


30.How can I access the C-Schedule?

Click ‘Other Resources’, then ‘Resource Links’, then ‘Fee Schedules and Rates’, and then ‘Accept’.


31. Can delegates access the C-Schedule?

Currently, no, but it should be resolved within the next two or three weeks.


32, How does an administrator link to all accounts?

After the administrator account is created, add each delegate to the account.


33. What is the call center number?

The call center phone number is 1-800-884-3222.


34. Do I have to create an account for each provider or can they be added under a group account?

A separate registration must be completed for each individual Medicaid ID.


35. What if my password does not match the security questions?

Click ‘Reset Password’. You will receive an email with further directions. Be sure to check your email’s spam/junk folders.


36. As an administrator, can I add myself as a new delegate and registered delegate?

Yes, this will allow you to have only one username and password and add other delegates from one account.


37. Where can I locate MUE Allowed Units?

There are currently no changes to the information as what is found on the CMS website.


38. What should the PIN be when registering for the provider portal?

For individuals, the PIN should be the last four digits of the tax ID number. For groups, it should be the last for digits of the tax ID number or last four numbers of the social security number.


39. What should I do if I cannot find a claim in the search queue?

Please contact the call center for further assistance. The call center phone number is 1-800-884-3222.


40. Can I submit a crossover claim on paper?

Yes, but you may not do so using the previous form used in Legacy. Any claims submitted using the old form will be rejected. Please review the Provider Manual for further information.


41. Can I manually add carrier codes for Medicare crossover claims?



42. Where can the carrier codes be found?

Carrier codes are listed on the provider portal under ‘Resources’.


43. What causes crossover claims to be automatically denied in the portal?

Crossover claims are automatically denied if the UNB is not attached to the claim.


 45. Are there delays in processing paper claims?

All claims are processed in order of receipt, as soon as possible.


46. What is the mailing address for paper claims?

Gainwell Technologies, P.O. Box 23076, Jackson, MS 39225.


47. Who can submit secure correspondences to request taxonomy changes?

The administrator can request a taxonomy change.


48. What is the turnaround time of response for secure correspondences?

We have several individuals working to respond as soon as possible.


49. What would cause an account to be denied for no authorization if the authorization has already been approved?

Please re-submit those claims. Also, ensure that the first character is a capital letter.


50. Where can the webinar schedule be accessed?

There is a red banner at the top of the MESA homepage. Once you click it, you will see more information on scheduled webinars.


51. Where can previously recorded webinars be accessed?

This information is currently not available. Please check back for updates.


52. Why are elderly, psych-social rehabilitation providers being denied for prior authorization when it was never required in the past?

Please provide your taxonomy, any modifiers, procedure code, and a note expressing the prior authorization is being required.


53. What if I never received a verification email after registering my account?

Try resetting the password manually and answering the challenge questions.


54. Can I delete a registered account and start over?

No, once an administrator account has been created, it cannot be deleted.


55. Has the error when billing for T1005 procedure code been resolved?

Yes, that was an audit for respicare, and it has been resolved. Please re-submit claims submitted prior to October 17, 2022.


56. Do the billing provider and rendering provider taxonomy code have to match?

Not always, group billing taxonomies will not always match that at the rendering level. Individual providers can leave the rendering features blank.


57. What does ‘Rendering Provider ID Not on File’ mean?

This is more specific and individualized and will need to be examined on a case-by-case basis.


58. What if there are multiple hospitals under one taxonomy – how is it determined which hospital to pay claims to?

Each hospital should be distinguishable by their zip code, and that should determine to which the claims are paid.


59. Is it required that all secondary claims be submitted through the portal?

No, secondary claims can be submitted in any form.


60. Do commercial primary claims have to have a primary EOB?

They can be submitted with an EOB through the portal and on paper, but it is not required through EDI.


61. Can Medicare Primary and Medicaid Secondary claims be submitted through the portal?

Yes, but the must include the Medicare EOB attachment.


62. How are Medicaid Secondary claims being applied to commercial plans, if the entire amount is applied to the deductible?

This is more specific and individualized and will need to be examined on a case-by-case basis.


63. What to do if I receive a ‘denial error’ message while submitting a claim in the portal?

The denial error message will explain the reason for the denial. To save time, there is a copy feature that will allow you copy the claim, make the necessary corrections, and re-submit it.


64. Are paid claims editable in the portal?

Yes, there is an edit feature that will allow you to make necessary adjustments to paid claims.


65. Is it possible to bypass the Medicare carrier codes in the portal?

No, this is a requirement.


66. Why are some codes shaded gray and inaccessible?

There are still updates being made, and this matter is being addressed as soon as possible.


67. Can a legacy claim be voided in the portal?

Any paid claims can be voided.


68. Is there a Mississippi Medicare carrier code?

No, not technically, but the code ‘MS_TXIX’ is available for use.


69. Is the Medicare ID the same as the carrier code?



Provider Portal Eligibility Verification

1. Do I have to be logged into the Provider Portal to check member eligibility?

Yes. You can only view member information after logging into the secure

2. Is eligibility verification a guarantee of coverage?

No. Eligibility verification only indicates the current state of coverage as reflected in the MMIS. Member coverage can change.


3. Why did my new Other Insurance record disappear?

When you enter an Other Insurance record, it is moved to a workflow for the Mississippi Division of Medicaid to verify and approve. The record will appear in the Other Insurance list after approval.


4. What if I enter an Other Insurance record twice?

Don’t worry, duplicate records are easily deleted from the worklist.


Portal Roles – Admin vs. Delegate & Fee Schedule Questions

1. Can a Provider have more than one Administrator?

There is only one Administer that can be registered on the Provider Portal.


2. Does every Provider need a Delegate?

Click here to find archived information and resources from the MMIS Replacement Project

The Delegate functionally is for more employees to register themselves on the Provider Portal with there own User ID and Password.


3. Who assigns Delegates and makes changes to a Delegate’s access/views?

The Administer is the one that grants the access to the delegates.


4. Who can see the Fee schedules & check Eligibility?

Both the Administer and Delegate can access the fee schedules and check eligibility on the portal. Under Resources then click on Search Fee Schedule.


5. Can we add NPIs to a Delegate’s account?

You can not add NPI to a delegate account.


6. Who has access and how do we link Provider’s to a Clinic?

The Administer has access to link providers to the Group.


7. We are trying to log in but it says the Challenge questions are wrong, what do we do?

Make sure the User ID you enter in on the login page is correct.


8. I am a Delegate, how do I get my email address changed and can my administrator see my email address?

The Delegate needs to login on the home screen under My Profile there you will be able to change your email address.


Eligibility Verification Questions


1. When verifying eligibility, the date I enter is the Effective Date of the eligibility. This is different from what we’re used. Will this be changed?

The date entered in the search for Eligibility is the date that is returned for eligibility verification. The panel is designed to return eligibility per Date entered in the search. This is a change from Conduent’s system and reinforces HIPAA security for only that information that is needed at a time.


2. When a member’s managed care medicaid plan changes from one to another plan how do I get the effective date of the change?

The current date of the enrollment that is displayed on the effective date of the Coverage is the first date of eligibility for that plan. There is no audit panel to look at on the web portal for a history of all plan assignments. Instead, enter a specific date prior to the current date to see if the previous CCO is displayed and review the effective dates.


3. Where do I find if a member has MSCAN or Chip?

The Plan is displayed under the Managed Care Assignment details panel under Benefit Plan. It is displayed as either MississippiCAN or MississippiCHIP.


4. How do providers know when the beneficiary has changed payers? For example Magnolia to Molina.

Provider can see this by looking at the current date of the enrollment that is displayed on the effective date of the Coverage. There is no audit panel to look at on the web portal. You can enter a specific date prior to the current to see if the previous CCO is displayed and review the effective dates.


Service History Questions


1. When will the patient’s Dental and Vision limits and amounts be posted?

The fix for the Dental and Vision limits to display on the Portal was put into MESA on Friday, 10/28/2022. These limits and remaining units balances are now displaying for all service limits; including Dental, Vision, Therapy, and Office Visits.


Taxonomy Questions


1. A Taxonomy webinar is being held on Tuesday, November 1, that will questions that arose during this webinar. Please attend and see the FAQ from that webinar for more information.



Crossover Questions


1. When will Medicare cross-over claims be pulled. Are we going to have to rebill them all online through MESA?

Gainwell Technologies and DOM are currently working with COBA to get all Medicare Crossover claims pulled. We do not have an ETA on when they will be pulled. We are planning on getting the back log from Medicare so that Providers will not have to manually submit these claims.


2. When doing a professional claim, it makes us put in the performing provider id#. it gave a denial until this was added. how are you doing a claim w/out this info?

Rendering Providers are only required when the Billing provider is enrolled as a group. If the Provider is an individual, the Rendering is not only not required, but it is suggested to leave completely blank.


3. Part C crossovers claims are being returned. Reason is claim form not accepted in MESA. For Medicare advantage members, the crossover for is the Part C form. Are there enhancements being made to accept this part C form?

All Medicare Part C Advantage Plan Claims can not be sent using the same CMS1500, UB04 or the 2012 Dental forms. They can also be filed through the Provider Portal or EDI batch. These claims need to be sent with all the information as any Medicare Xover at the correct levels (Header or detail) by setting the “Claim Filing Indicator = 16”. These claims will process as directed by state policy.


4. How do you find out why a secondary claim denied?

This can be done by pulling up the claims in the Provider portal, reviewing RAs/835s, or calling the Provider Call Center.


5. The YouTube video tutorial said NOT to enter Medicare Crossover Details but to check the box instead?

This is in the process of being updated/corrected.


6. How do I submit a Medicare C claim?

Medicare C plans need to be submitted just like Medicare Crossovers with the only difference being that the Code Filing Indicator field in the Other Insurance section of the claim set to 16.


7. We were told on one of the Webinar that we were not supposed to fill in the Medicare part on the first page, that it was supposed to be left blank. Is this still the case?

This is currently a known defect. Currently Providers do need to fill out the Other Insurance portion at the header, but only fill out the Medicare portion at the Detail for Professional Crossovers, Outpatient Crossovers, and Dental Part C Crossovers.


8. My claims are denying for code 1470. What is this code?

EOB 1470 is a PAID edit and is not the cause of a claim denials. This is an informational EOB only. Every Medicaid State has this change in place.


9. Can you file Medicare C claims electronic not thru website?

Yes, you will need to still send the EOB by mail, and you will need to fill out the information in the correct X12 loops for other insurance with the claim filing indicator of 16.


10. Do we add the Medicare crossover details in the header or in the line item?

The Medicare payment information for Professional, Outpatient, and Dental Part C Crossovers will need to have the Detail information sent. Inpatient and Long term Care Crossovers only need the Detail.


11. Do we have to click the include other insurance when filing a Medicaid Part C claim, when a Medicare Advantage plan is primary?

All Medicare Crossover claims, including All Medicare C claims, will have to have the Other Insurance section filled out. For Medicare Part C claims, the Claim Filing Indicator will need to be set to 16.


12. If we have multiple service lines do we enter the information for each line item under the crossover details or do we enter total amounts for the entire claim?

Each detail needs to be filled out exactly as it is listed on the EOMB from Medicare. If there is Detail information on the EOMB, that information must match the Crossover Claim.


13. If it is a Dual plan like United or Aetna as primary, do I submit a crossover professional or just professional?

If none of the Primary and Secondary are Medicare or Medicare C advantage plans, then send as a plain professional claim.


Claims Not Processed by Conduent Questions


1. How are claims being handled that were never processed by Conduent before moving to MESA? I am trying to submit these now and getting a timely filing errror in MESA.

TBD – Gainwell will fill in this answer soon. Please check back at a future date.


2. We submitted claims via regular mail and certified mail to Conduent. MESA says they do not have them. What do I do now?

TBD – Gainwell will fill in this answer soon. Please check back at a future date.




1. If the provider is a group, will we always have to add all of the additional information?

If the Billing Provider is a Group Provider, all Details are required to have a rendering provider submitted.


2. Do you have to copy the claim in order to file a corrected claim, rather than use the “edit” option?

The Edit option is only for the Adjustment of a paid claim in the MESA system. Copy is to be used for all other corrections.


3. What is a claim filing code?

The Claim Filing Code is used to determine the type of other insurance is being submitted with the claim. In the case of Medicare Crossovers, it will be MA, MB, or 16 for Medicare C Advantage Plans.



Providers that are submitting claims through the provider portal for themselves are having payment issue with the rendering provider field on the detail. This can be mitigated for providers billing for services they themselves rendered by filing a claim without filling out any of the Facility or Rendering provider fields at the header or the detail. Leaving these fields blank will allow for the system to know that the Biller is the rendering provider and the claims will process correct.