Managed Care – MississippiCAN (MSCAN) and Children’s Health Insurance Program (CHIP) Forms
MSCAN and CHIP Forms
| Title | File Name | Caption | Date |
|---|---|---|---|
| MississippiCAN Inquiry/Complaint Form | MississippiCAN-Inquiry-Complaint-Form.pdf | May 24, 2017 2:11 pm | |
| CHIP-Change-of-Plan-Form-for-Mandatory-Groups | CHIP-Change-of-Plan-Form-for-Mandatory-Groups.pdf | September 9, 2019 8:55 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 | August 7, 2018 7:46 pm | |
| MississippiCAN Enrollment Form for Mandatory Groups | MississippiCAN-Enrollment-Form-for-Mandatory-Groups.pdf | August 7, 2018 7:47 pm | |
| MississippiCAN Change of Plan Form for Optional Groups | MississippiCAN-Change-of-Plan-Form-for-Optional-Groups.pdf | August 7, 2018 7:52 pm | |
| MississippiCAN Change of Plan Form for Mandatory Groups | MississippiCAN-Change-of-Plan-Form-for-Mandatory-Groups.pdf | August 7, 2018 7:50 pm | |
| 2019 MississippiCAN Provider Survey | Provider-Survey-2019.pdf | August 26, 2019 5:43 pm |
Beneficiaries
- Magnolia Health provider directory – access the provider directory for Magnolia Health to find a doctor clinic or hospital
- UnitedHealthcare Community Plan provider directory – access the provider directory for UnitedHealthcare Community Plan to find a doctor clinic or hospital
- Magnolia Health website
- UnitedHealthcare Community Plan website
- Magnolia Health brochure
- UnitedHealthcare Community Plan brochure
- Health benefit plan comparison chart for MississippiCAN and CHIP.
Providers
- Provider survey letter
- Provider survey feedback
- Magnolia Health prior authorization form for non-mental health service
- Magnolia Health Electroconvulsive Therapy (ECT) OTR form
- Magnolia Health Injectable Antipsychotic Authorization form
- Magnolia Health Intensive Outpatient Program (IOP) Authorization form
- Magnolia Health mental health provider directory
- UnitedHealthcare Community Plan Prior Authorization form for non-mental health service
- UnitedHealth Community Plan 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
- MississippiCAN Estimated Program Savings Summary – Jan. 2011 – June 2019
- MississippiCAN and CHIP Companion Guides
MississippiCAN Contracts
UnitedHealthcare Community Plan
Jan. 2011 – June 2014 contract
July 2014 – June 2018 contract
July 2017 – June 2020 contract documents
- MSCAN Contract Projected Expenditures
- MSCAN Request for Proposals
- UnitedHealthcare Community Plan July 2017 – June 2020 Contract
- UnitedHealthcare Community Plan July 2017 – June 2020 Contract Amendment #1
- United Healthcare Community Plan July 2017 – June 2020 Contract Amendment #2
- United Healthcare Community Plan July 2017 – June 2020 Contract Amendment #3
- United Healthcare Community Plan July 2017 – June 2020 Contract Amendment #4
- Exhibit A MSCAN Contract Amendment #4 – UHC
Magnolia Health
Jan. 2011 – June 2014 contract
July 2014 – June 2018 contract
July 2017 – June 2020 contract documents
- MSCAN Contract Projected Expenditures
- MSCAN Request for Proposals
- Magnolia Health July 2017 – June 2020 Contract
- Magnolia Health July 2017 – June 2020 Contract Amendment #1
- Magnolia Health Plan July 2017 – June 2020 Contract Amendment #2
- Magnolia Health Plan July 2017 – June 2020 Contract Amendment #3
- Magnolia Health Plan July 2017 – June 2020 Contract Amendment #4
- Exhibit A MSCAN Contract Amendment #4 – MHP
Molina Healthcare
July 2017 – June 2020 contract documents
- MSCAN Contract Projected Expenditures
- MSCAN Request for Proposals
- Molina Healthcare July 2017 – June 2020 Contract
- Molina Healthcare July 2017 – June 2020 Contract Amendment #1
- Molina Healthcare July 2017 – June 2020 Contract Amendment #2
- Molina Healthcare July 2017 – June 2020 Contract Amendment #3
- Molina Healthcare July 2017 – June 2020 Contract Amendment #4
- Exhibit A MSCAN Contract Amendment #4 – MHMS
Children’s Health Insurance Program (CHIP) Contracts
Mississippi External Quality Review
Presentations
Mental Health Resources
UnitedHealthcare Community Plan - Mental Health Information
- UnitedHealth Community Plan Authorization Request Form
- OptumHealth Behavioral Solutions
To access OptumHealth provider directory go to: Optum Network Manual
