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Providers should note pharmacy changes for children transitioning from Medicaid to MississippiCAN

From May 1, 2015 through July 31, 2015, all children up to the age of 19, will be transitioned from traditional Medicaid to MississippiCAN. The transition will occur incrementally in months May, June, and July. Exceptions are those beneficiaries who are dually eligible (Medicaid/Medicare), enrolled in a waiver, living in a long term care (LTC) facilities including but not limited a PRFT or ICF/IDD facility and those beneficiaries with hemophilia. There are no changes to coverage or any loss of benefits.

What do pharmacists need to know?

  1. Beneficiaries receive notices in mail and must choose between Magnolia Health and UnitedHealthcare.
  2. If beneficiaries do not complete and return form, then they are automatically assigned to one of the plans. Those who are automatically assigned have a 90 day grace period to change plans. If no change is made during the grace period, then beneficiary must wait until annual enrollment period in October to change plans with that change becoming effective the following January 1.

Health care providers should verify eligibility and plan at each date of service to assure correct billing. To verify eligibility and MississippiCAN assignment, providers can:

  • Use Xerox’s Automated Voice Response System, or AVRS, toll-free at 800-884-3222. You will need the beneficiary’s a social security number and/or Medicaid ID# to determine enrollment in Magnolia Health or UnitedHealthcare plan.
  • Use Xerox’s WEB PORTAL. If you are not registered to use the web portal, contact Xerox toll-free at 800-884-3222 to request assistance.

POS claims processed to DOM for beneficiaries enrolled in MississippiCAN:

  • NCPCP Reject Code ‘41-SUBMIT BILL TO OTHER PROCESSOR’ with the following NCPDP 526 (Free Text Messages):
    • If enrolled in UHC-BILL MSCAN PLAN: UNITED HEALTHCARE 1-877-305-8952; BIN#610494 GROUP:ACUMS
    • If enrolled in Magnolia -BILL MSCAN PLAN: MAGNOLIA HEALTH PLAN INC ‘ 1-800-460-8988; BIN#008019: GROUP 14101

Learn more information about the transition by reading – Medicaid to transition children into MississippiCAN managed care program