Medicaid Fee for Service (FFS) claims: Beginning Aug. 21, 2014 at 12:01 a.m., pharmacy point of sale (POS) fee for service (FFS) claims will be reimbursed at the previous payment rate used prior to July 1, 2014. Be advised that the Aug. 25, 2014 Remittance Advice (RA) may reflect payments with two reimbursement methodologies. Please continue to check the Mississippi Medicaid website at https://medicaid.ms.gov and Late Breaking News for updates.
Xerox will reprocess POS FFS claims, with dates of services from July 1 through Aug. 20, 2014, on a weekly basis starting Sept. 2, 2014 until completed. DOM requests that pharmacy providers refrain from reversing and resubmitting claims with dates of service within this time frame. Providers are encouraged to check their RAs weekly until reprocessing is finalized.
MississippiCAN Pharmacy Claims: Magnolia Health Plan is working to return to the previous POS pricing methodology used prior to July 1, 2014. This change will require Magnolia to make programming updates and review contracts with pharmacies. Magnolia hopes to have this work completed within 60 days or less. Once the work is complete, Magnolia will send notification and you will be able to void your previous claim and resubmit the claim to pay at the pre July 1, 2014 price. Magnolia will keep you informed as we work through this process.
United HealthCare has continued to pay at the pre July 1, 2014 price and will continue to do so.