Managed Care – MississippiCAN and Children’s Health Insurance Program (CHIP) Forms
| Title | File Name | Caption | Date |
|---|---|---|---|
| 2014 MississippiCAN Provider Survey | 2014MSCANProviderSurvey.pdf | October 8, 2014 4:05 pm | |
| CHIP Change of Plan Form for Mandatory Groups | CHIP-Change-of-Plan-Form-for-Mandatory-Groups.pdf | June 16, 2015 10:05 pm | |
| CHIP Enrollment Form | CHIP-Enrollment-Form.pdf | June 16, 2015 10:06 pm | |
| MississippiCAN Enrollment Form for Optional Groups | MississippiCAN-Enrollment-Form-for-Optional-Groups.pdf | June 16, 2015 10:06 pm | |
| MississippiCAN Enrollment Form for Mandatory Groups | MississippiCAN-Enrollment-Form-for-Mandatory-Groups.pdf | June 16, 2015 10:06 pm | |
| MississippiCAN Change of Plan Form for Optional Groups | MississippiCAN-Change-of-Plan-Form-for-Optional-Groups.pdf | June 16, 2015 10:06 pm | |
| MississippiCAN Change of Plan Form for Mandatory Groups | MississippiCAN-Change-of-Plan-Form-for-Mandatory-Groups.pdf | June 16, 2015 10:06 pm |
Beneficiaries
- Magnolia provider directory – access the provider directory for Magnolia Health Plan to find a doctor clinic or hospital
- UnitedHealthcare provider directory – access the provider directory for Magnolia Health Plan to find a doctor clinic or hospital
- Magnolia Health website
- UnitedHealthcare website
- Magnolia Health brochure
- UnitedHealthcare brochure
- MississippiCAN Health comparison chart – see the health plans and benefits they offer
Providers
- Provider survey letter
- Provider survey feedback
- Magnolia prior authorization form for non-mental health service
- Magnolia Electroconvulsive Therapy (ECT) OTR form
- Magnolia Injectable Antipsychotic Authorization form
- Magnolia Intensive Outpatient Program (IOP) Authorization form
- Magnolia mental health provider directory
- UnitedHealthcare Prior Authorization form for non-mental health service
- UnitedHealth Authorization Request Form
Documents
- MississippiCAN frequently asked questions
- MississippiCAN program design summary – revised Jan. 7, 2013
- MississippiCAN program design summary – revised Nov. 2012
- MississippiCAN program design summary – revised March 1, 2010
- 2015 Coordinated Care Organization (CCO) contract
- Children’s Health Insurance Program (CHIP) contract
