Managed Care – MississippiCAN and Children’s Health Insurance Program (CHIP) Forms
| Title | File Name | Caption | Date |
|---|---|---|---|
| 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 | 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 | |
| MississippiCAN Inquiry/Complaint Form | MississippiCAN-Inquiry-Complaint-Form.pdf | May 24, 2017 2:11 pm | |
| 2018 MississippiCAN Provider Survey | 2018-MSCAN-Provider-Survey.pdf | August 7, 2018 7:42 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 UnitedHealtcare to find a doctor clinic or hospital
- Magnolia Health website
- UnitedHealthcare website
- Magnolia Health brochure
- UnitedHealthcare brochure
- Health benefit plan comparison chart for MississippiCAN and CHIP.
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
MississippiCAN Contracts
Children’s Health Insurance Program (CHIP) Contracts
