Prior Authorization
Medicaid and MississippiCAN Pharmacy Prior Authorization Contacts
| Payer | Provider Contact | Beneficiary Contact |
|---|---|---|
| Mississippi Medicaid Pharmacy PA | Toll-free: 877-537-0722 Phone: 601-359-6685 Fax: 877-537-0720 |
Toll-free: 800-421-2408 Phone: 601-359-6050 |
| MississippiCAN Magnolia Pharmacy Help Desk |
PBM is US Script, Inc. Toll-free: 800-460-8988 |
Toll-free: 866-912-6285 Phone: 601-863-0700 |
| MississippiCAN UnitedHealthcare Pharmacy Help Desk |
PBM is OptumRX Toll-free: 877-305-8952 |
Toll-free: 877-743-8731 |
Keep in mind that MississippiCAN claims and PA requests must be submitted to the respective PBM. Submitting claims and/or prior authorization requests to Medicaid rather than to the respective plan delays the process for Medicaid, providers and beneficiaries.
Prior Authorization Forms
- Magnolia Prior Authorization form for non-mental health service
- UnitedHealthcare Prior Authorization form for non-mental health service
Mental Health Coverage
Magnolia Mental Health Information
- Magnolia Electroconvulsive Therapy (ECT) OTR form
- Magnolia Injectable Antipsychotic Authorization form
- Magnolia Intensive Outpatient Program (IOP) Authorization form
- Magnolia Provider Directory
UnitedHealthcare Mental Health Information
OptumHealth Behavioral Solutions
To access OptumHealth provider directory go to:
- Optum Network Manual
- Optum website
- Mississippi Division of Medicaid Mental Health Services
