Magnolia health plan provider manual. com and click on “Find a Provider.

Magnolia health plan provider manual Submit treatment plan & goals for PA of continued s vices. wellcare. 1-877-941-9235 : 5 October 19, 2016 HOW TO USE THIS PROVIDER MANUAL-----6 NONDISCRIMINATION OF HEALTH CARE SERVICE DELIVERY -----7 Welcome to Ambetter from Magnolia Health (“Ambetter”). We can assist in locating an in-network adult care provider or arranging care if needed Skip to main content Magnolia Health Medicaid Services Requiring Prior Authorization (PA) *Annual Review 12/1/2023 Provider Manual for details. magnolia health. Phone Fax/Web Address ; Provider Services ; 1-877-687-1187 ; NA : Providers can visit Magnolia Health’s Provider Portal at MagnoliaHealthPlan. Access reference materials, medical management forms, and more. If you have any questions, please contact Provider Engagement and Relations. Services managed 1. VHP’s Provider Manual has been redesigned based on feedback provided by VHP’s community of Providers, enhanced to VHP's Provider Manual has been redesigned based on feedback by VHP's community of Providers, enhanced to assist you in responding to questions from VHP’s Members, includes a Quick Reference Guide (QRG) that contains VHP resource information, Manuals and Forms Magnolia Health. For more information on your right to receive an Ambetter from Magnolia Health plan free of discrimination, or Magnolia Health offers insurance plans that include prescription drug coverage. If you are uncertain that prior authorization is needed, please submit a request for an accurate response. In 2023, our team redesigned the Provider Manual to make it easier for you to view and find important information and procedures for If further resource assistance is needed, please contact the Magnolia Health Care Management Department at 1-866-912-6285 to speak with a staff member. 24/7 Interactive Voice Response system: Enter the Member ID Number and the month of service to comprehensive and timely information to its providers through this Provider Manual (“Manual”) regarding Ambetter’s operations, policies and procedures. Apply to become a provider for individuals covered by Absolute Total Care Medicaid plans and learn more about Absolute Total Care today. 6 Health Plan Address . Expand The CAHPS survey scores are made available to the public and can determine whether patients and members stay with their provider or health plan or look elsewhere for their care. Discharge Planning and Readmission for Providers; Outpatient Clinical Documentation: MNC, SMART Goals for Treatment . Updates to this In addition to formal provider education processes, the Provider Manual is a comprehensive resource of information providers will need to function effectively and participating providers, hospitals, and other healthcare professionals. Magnolia Health, 111 E. Magnolia Health Plan P. Skip to Main Content. 30 MISSISSIPPI MEDICAID HYSTERECTOMY ACKNOWLEDGMENT FORM Patient Name(1) MS Medicaid ID#(2) Street Address(3) City, State, Zip(4) Diagnosis(5) Date Of Hysterectomy(6) Name Of Physician(7) MS Medicaid Provider #(8) As state and federal governments move toward a quality-driven healthcare industry, HEDIS ® rates are becoming more important for both health plans and individual providers. Capitol Street, Suite 500, Jackson, MS 39201. Our number-one priority is the promotion of healthy lifestyles through preventive healthcare. Please provide accurate information as follows Welcome to Ambetter from Magnolia Health. The information presented here is representative of our network of products. We thank you for being a part of Magnolia’s network of participating providers, hospitals, and other healthcare professionals. com An experienced provider network is essential to provide consistent, superior services to our members. PROVIDER AND BILLING MANUAL 2025 Ambetter from Magnolia Health is underwritten by Ambetter of Magnolia, Inc. Learn about Magnolia Health’s prescription drug coverage for members. View our provider resources online now. Provider Manual. Phone Numbers . ©2025 Ambetter of Magnolia Inc. 1 prescription medications to members enrolled in certain health plans which include a Part D benefit. Mail completed form(s) and attachments to: Magnolia Health Plan PO Box 3090 Farmington, MO 63640-3800 Magnolia Health provides the tools and support you need to deliver the best quality of care. Dental Services (21 years and older) Inial evati luation does not require PA for Par providers. Ambetter from Magnolia Health is underwritten by Ambetter of Magnolia, Inc. Throughout your ongoing relationship with Dental Health & Wellness, this provider manual will give you Medicare Member Plan Benefits Resume for Applicable COVID-19 Testing, Screening, and Treatment Services on May 12, 2023 Provider Manuals 2025 Magnolia Health MississippiCAN Provider Manual (PDF) Envolve Dental Provider Manual This provider manual is a reference guide for you and your staff servicing members who are members enrolled in certain health plans which include a Part D benefit. Notice: In order to maintain a current practitioner/provider profile, practitioners/providers are Magnolia Health is pleased to partner with PaySpan Health to provide an innovative web based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). It is important that providers ensure Magnolia Health has accurate billing information on file. cenpatico. Claim Appeal Form (PDF) CMS 1500 Claim Form Instructions (PDF) Magnolia Health offers trainings for both behavioral health and physical health providers in our network at no cost. com Call us toll free: 866-912-6285 www. Dental Services (21 years and older) $2,500/year YES: Contact Envolve Dental at 1-866-912-6285. Home; Login; Careers; Contact Medicare Member Plan Benefits Resume for Applicable COVID-19 Testing, Screening, and Treatment Services on May 12, 2023 Behavioral Health Provider Training HOW TO USE THIS PROVIDER MANUAL Ambetter from Magnolia Health Plan . We thank you for being part of Magnolia’s network of participating providers, hospitals, and other healthcare professionals. Emergent and palliative Magnolia Health Plan Author: Magnolia Health Subject: Magnolia Health Medicaid Services Prior Authorization List Keywords: Magnolia Health is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Magnolia Health members. Please contact the provider services department HEALTH PLAN INFORMATION Health Plan address Magnolia Health Plan 111 East Capitol Suite 500 Jackson, MS 39201 Phone Numbers Phone TTY/TDD 1-877 -687 -1184 1-877 -941 -9235 Department Phone Fax Provider Services 1-877 -687 -1187 Member Services 1-877 -687 -1187 Medical Management Inpatient and Outpatient Prior Authorization Health Insurance Marketplace. Please do not include this form with a corrected claim. Creating an account is free and easy. Verification Procedures 41 Clean Claim Definition 42 Non-Clean Claim Definition 43 Upfront Rejections vs. Contact Provider Service at 1-877-687-1187. Provider Participation, Contracting, and Ambetter from Magnolia Health is underwritten by Ambetter of Magnolia Inc. As state and federal governments move toward a quality-driven healthcare industry, HEDIS ® rates are becoming more important for both health plans and individual providers. ©2025 Ambetter of Magnolia, Inc. MagnoliaHealthPlan. A new window will open. com and click on “Find a Provider. Our number-one priority is the promoon of healthy lifestyles through Ambetter from Magnolia Health provides the tools you need to deliver the best quality of care. Welcome to Ambetter from Magnolia Health Provider and Billing Manual 2022 Ambetter. Providers billing miscellaneous codes must submit medical documentation that clearly Magnolia health plan provider manual Every gift to the Arthritis Foundation helps people with arthritis across the United States live their best lives. 41. CLAIMS. In addition, Magnolia Health may from time to time employ a vendor that applies payment policies to specific services; in such circumstances, the vendor’s guidelines may also be used to determine whether a service has been Ambetter from Magnolia Health. Vision services, including all services rendered by an Optician, Ophthalmologist or Optometrist need to be verified by Envolve Vision Policies in the Magnolia Health Payment Policy Manual may have either a Magnolia Health or a “Centene” heading. Ambetter. Newsletters Q3 2023 Provider Newsletter (PDF) Ambetter’s My Health Pays Member Rewards Program----- 39. In doing so, Envolve Vision will make the Provider Manual available to Providers via the Envolve Vision website and upon a Provider’s request. To facilitate the manual review, providers are required to submit medical records with the initial claims submission. , Ambetter. Health Insurance Marketplace. If the records are not submitted, the provider receives a denial indicating that medical records are required. Medicare Member Plan Benefits Resume for Applicable COVID-19 Testing, Screening, and Treatment Services on May 12, 2023 2025 Magnolia Health MississippiCAN Provider Manual (PDF) Envolve Dental Provider Manual (PDF) Envolve Vision Provider Manual (PDF) Ambetter from Magnolia Health 4 HOW TO USE THIS PROVIDER MANUAL 4 KEY CONTACTS AND IMPORTANT PHONE NUMBERS 4 SECURE PROVIDER PORTAL 5 Functionality 6 PROVIDER ADMINISTRATION AND ROLE OF THE HOW TO USE THIS PROVIDER MANUAL -----7 KEY CONTACTS AND IMPORTANT PHONE Ambetter is a Qualified Health Plan (QHP) issuer as defined in the Affordable Care Act (ACA). The CAHPS survey scores are made available to the public and can determine whether patients and members stay with their provider or health plan or look elsewhere for their care. For detailed information, please refer to the Magnolia Health Provider Manual. Mail completed form(s) and attachments to: Magnolia Health Plan PO Box 3090 Farmington, MO 63640-3800 . please submit the corrected claim following the “Corrected Claim” process in the provider manual. Magnolia works This Provider Manual is a reference guide for providers and their staff providing services to • Providers must comply with Plan processes to identify, access, and establish treatment • Provider shall disclose to Magnolia Health Medicare Advantage all offshore contractor Ancillary Provider Manuals ----- 9 NONDISCRIMINATION OF HEALTHCARE SERVICE DELIVERY ----- 10 KEY CONTACTS & IMPORTANT PHONE NUMBERS ----- 11 Qualified Health Plan (QHP) Enrollee Survey ----- 122 Ambetter from Magnolia Health Ambetter from Magnolia Health 1020 Highland Colony Parkway, Suite 502 Ridgeland, MS 39157 If further resource assistance is needed, please contact the Magnolia Health Care Management Department at 1-866-912-6285 to speak with a staff member. Expand Magnolia Health Plan | November 27, 2023 1 Magnolia Health Plan 2023 External Quality Review Submitted: November 27, 2023 In addition to formal provider education processes, the Provider Manual is a comprehensive resource of information providers will need to function effectively and appropriately within the network. Submit treatment plan & goals for PA of continued services. magnoliahealthplan. Log onto DOM’s MESA website to verify a member’s eligibility with Magnolia Health MississippiCAN. contact Magnolia Health or reference the information in the Provider Manual. If you, or someone you’re helping, have questions about Amb. Medicare Member Plan Benefits Resume for Applicable COVID-19 Testing, Screening, and Treatment Services on May 12, 2023; Provider New Name. Ambetter’s Health Insurance This provider manual aims to deliver comprehensive information to providers regarding Magnolia’s operations, benefits, and policies and procedures. These forms are maintained by the health plan, but you can access the form for your state below. Browse our resources & tools today. This service is provided at no cost to providers and allows online enrollment. . 111 Magnolia Health MS CHIP Plan Benefits . Phone Numbers. which is a Qualified Health Plan issuer in the Mississippi Health Insurance Marketplace. dba The Health Plan (THP) appreciates our physicians, practitioners, hospitals, and ancillary providers and values your dedication and commitment to serve our community. Improving and practicing cultural awareness, humility and mindfulness can help you better understand and respond to the needs of patients while maintaining a professional level of respect Learn about Mississippi health insurance and health care plans from Magnolia Health. Table of Contents. A few areas of are subject to a manual review. com Health Plan address . Magnolia Health provides its healthcare providers with the best tool & resources they need to provide care. Enroll or become a provider today. You can request a provider directory listing Magnolia Health providers to choose from, including providers, hospitals and the provider’s office hours. Phone TTY/TDD; 1-877-687 Cenpatico Mississippi Provider Manual Page 2 www. Findings The findings of the 2015 EQR indicate that Magnolia Health Plan improved their percentage of met scores in the areas of Provider Services, Utilization Management and State-Mandated. Using this secure website, you can check member eligibility. © 2022 Ambetter of Magnolia Inc. Ambetter 111 East Capitol Street, Suite 500 Jackson, MS 39201 . Welcome to Ambetter from Magnolia Health. Phone Fax/Web Address ; Provider Services ; 1-877-687-1187 ; NA : HOW TO USE THIS PROVIDER MANUAL Ambetter from Magnolia Health Plan . We have partnered with Magnolia Health, our sister company, to administer dental benefits for their members in the Magnolia Health managed care program called Mississippi Coordinated Access Networks (MississippiCAN). MUST BE BILLED w/G MODIFIERS (GN, GO, GP). Providers can Provider Services Department: 1-866-912-6285 or www. com We thank you for being a part of Magnolia’s network of parcipang providers, hospitals, and other healthcare professionals. Important Notice: Magnolia Health Plan will make reasonable efforts to resolve this Effective November 7, 2016, Magnolia Health will be expanding its Provider Services and Call Center to better meet provider needs. We can make your choice of PCP effective on the next business day. 24/7 Interactive Voice Response system: Enter the Member ID Number and the month of service to check eligibility. 2 | Magnolia Health Provider Services Department: 1-866-912-6285; (TDD/TTY) 1-877-725-7753, Relay 711 | www. Ambetter offers affordable health care coverage for individuals and families. By logging into the How to Use This Manual Magnolia is committed to working with our provider community and members to provide a high level of Utilizing Magnolia’s website can significantly reduce the number of telephone calls providers need to make to the health plan. Magnolia Health Plan and PaySpan Health Benefits to Providers: Free service – Providers are not charged any fees to use the service Eliminate re-keying of remittance data – Electronic remittance advices can be imported directly into Practice Management or Patient Accounting Systems, eliminating the need for manual keying off of paper advices The provider’s role in Magnolia Health's Care Coordination program is extremely important. Magnolia works Provider Manual 2023 MISSISSIPPI PRO_108372E Internal Approved MMDDYYYY ©Wellcare 2023 . For specific details, please refer to the provider manual. The Ambetter Member ID contains the Need to review your existing information or have a question? If you are a contracted provider you can visit our Provider Directory to review your information. Dental Services (21 years and older) Initial evaluation does not require PA for Par providers. How to Use This Manual Magnolia is committed to working with our provider community and members to provide a high level of Utilizing Magnolia’s website can significantly reduce the number of telephone calls providers need to make to the health plan. Please contact the Provider Services The public portion of our website located at Ambetter. Wellcare By Allwell Create your own health plan online account today! Magnolia Health has many convenient and secure tools to assist you and give you access to better to healthcare information. Phone TTY/TDD HOW TO USE THIS PROVIDER MANUAL If a practitioner/provider already participates with Magnolia Health Plan in the Medicaid product, the practitioner/provider will NOT be separately credentialed for the Ambetter product. Depending on family size and income, a person may even qualify for help to pay their monthly premium. You will be able to login or register. Dental claims should be Provider Manual and Forms; Provider newsletters; Provider Directory; Access to link to the State’s PDL; Magnolia’s Secure Portal -https: For more information on your right to receive an Ambetter from Magnolia Health plan free of discrimination, or your right to receive language, auditory and/or visual assistance services, please visit Create your own health plan online account today! Magnolia Health has many convenient and secure tools to assist you and give you access to better to healthcare information. Envolve Vision will Provider Policy Manual Hospital Inpatient Page 2 of 3 Section: 25. Ambetter from Magnolia Health is underwritten by Ambetter of Magnolia Inc. 1-877-941-9235 : 5 May 23, 2017 HOW TO USE THIS PROVIDER MANUAL-----7 NONDISCRIMINATION OF HEALTH CARE SERVICE DELIVERY----- 8 KEY CONTACTS AND IMPORTANT PHONE NUMBERS Qualified Health Plan (QHP) Enrollee Survey 93 Provider Performance Monitoring and Incentive Programs 93. Ambetter’s Health Insurance Marketplace plans target a consumer population of lower income, previously uninsured individuals, and families who, prior to having this health insurance, may HOW TO USE THIS PROVIDER MANUAL 4 KEY CONTACTS AND IMPORTANT PHONE NUMBERS 4 SECURE PROVIDER PORTAL 5 Functionality 6 Health Plan address Ambetter from Magnolia Health 111 East Capitol Suite 500 Jackson, MS 39201 Phone Numbers Phone TTY/TDD 1-877-687-1187 . Providers can Welcome to Allwell from Magnolia Health(Allwell) . FROM I Policies in the Magnolia Health Payment Policy Manual may have either a Magnolia Health or a “Centene” heading. , which is a Qualiied Health Plan issuer in the Mississippi Health Insurance Marketplace. Capitol Street, Suite 500 Jackson, MS 39201. On Wednesday, the company launched a new service for healthcare providers to order, track and view patient genetic test results. Provider Manual 2023 MISSISSIPPI PRO_108372E Internal Approved 08302022 ©Wellcare 2023 . Vision services need to be verified by Centene Vision Services. Providers must use a participating Magnolia Health Plan hospital. < Magnolia Health> Address: Allwell from Magnolia Health 111 E. com 3252266_MS4PMKTMANE PRO_3252266E Internal Approved MMDDYYYY measures, validation of consumer and provider surveys, and a review of the health plan’s Information System Capabilities Assessment. Allwell . Denials 43 Timely Filing 43 Refunds and Overpayments 44 Who Can File Claims? 44 Electronic Claims Submission 45 Online Claim Submission 48 2024 Dental Provider Manual (PDF) Out of Network Provider Resources some providers must submit the outpatient authorization form. Please allow up to 30 days for evaluation and Magnolia Health Plan encourages our providers to engage in Cultural Compentency training and education to promote positive interaction with diverse cultures. 1 December 8, 2022 TABLE OF CONTENTS certain health plans which include a Part D benefit. Provider New First Name * Error: This field is required. 26. Newsletters Q3 2023 Provider Newsletter (PDF) HOW TO USE THIS PROVIDER MANUAL 4 KEY CONTACTS AND IMPORTANT PHONE NUMBERS 4 SECURE PROVIDER PORTAL 5 Functionality 6 Health Plan address Ambetter from Magnolia Health 111 East Capitol Suite 500 Jackson, MS 39201 Phone Numbers Phone TTY/TDD 1-877-687-1187 . Prescription medications and certain over-the-counter medications are covered with a written order from a Mississippi Medicaid provider. com will contain the Provider Manual, the Billing Manual and Quick Reference Guides which will provide user of the Magnolia Health Plan secure portal, you do NOT need a separate registration. Join us and become the champion of Jesus. Magnolia Health Medicare Advantage 111 East Capitol Suite 500 Jackson, MS 39201 Phone Numbers Phone TTY/TDD Magnolia Health Medicare Advantage 1-844-786-7711 711 Department Phone Fax Provider Services 1-844-786-7711 1-866-796-0523 Member Services na Provider Manual as it relates to Envolve Vision’s operation, benefits, and guidelines to Providers. Magnolia Health's plan is called Ambetter. Due to the growth of members and our provider network, providers will not be limited to a single Provider Relations Specialist, but will be able to use several communication tools. Manuals, Forms and Resources Pharmacy Prior Authorization requests may be submitted to GWT electronically via the MESA provider portal or by fax: Electronically: https: Provider Manual for details. Magnolia Health can also help you pick a PCP. Our number one priority is the promotion of healthy lifestyles through Magnolia Health, Wellcare, Wellcare By Allwell and Ambetter are affiliated products serving Medicaid, Medicare and Health Insurance Marketplace members, in the State of Mississippi respectively. Thank you for your interest in participating with Magnolia. Ambetter Ambetter from Magnolia Health 111 East Capitol Street Suite 500 Jackson, MS 39201. To enter our secure portal, click on the login button. Magnolia’s website is located at www. Ambetter 111 East Capitol Street Suite 500 Jackson, MS 39201 1-877-687-1187 Relay 711 . This will allow you to view other participating providers in the Ambetter from Magnolia Heal th network. ” If you would like a printed copy of our Provider Directory, please call 1-866-912-6285 , Relay 711, or you can find one at your Division of Medicaid Regional Office or your local WIC office. We can assist in locating an in-network adult care provider or arranging care if needed please submit the corrected claim following the “Corrected Claim” process in the provider manual. com . Practitioners who have identified a member who they think would benefit from disease or case management should contact the Care Coordination Department to speak with a member of our Integrated Care Team at 866-912-6285. Non-contracted providers may request a contract by completing the form at the link provided below. please refer to the Magnolia Health . Magnolia works to Welcome to Magnolia Health (Magnolia). We encourage providers to use this method first when attempting to verify eligibility. BLE: Benefit Limit Magnolia Health Plan Outpatient Medicaid Authorization Form (PDF) MS Benefit Limit To find out who is a participating provider with Magnolia Health, visit MagnoliaHealthPlan. If you are a non-contracted provider, please call Provider Services at 866-912-6285. com AMB21-MS-HLK-00073 . user of the Magnolia Health Plan secure portal, you do NOT need a separate registration. Wellcare By Allwellis designed to achieve four main objectives: Magnolia Health, please review these guidelines below. In addition, Magnolia Health may from time to time employ a vendor that applies payment policies to specific services; in such circumstances, the vendor’s guidelines may also be used to determine whether a service has been Ambetter from Magnolia Health is underwritten by Ambetter of Magnolia Inc. Behavioral Health; Provider Training; Special Supplemental Benefits; Eligibility Verification; Forms and Resources; Medicare Member Plan Benefits Resume for Applicable COVID-19 Testing, Screening, and Find out if you need a Medicaid pre-authorization with Magnolia Health's easy Pre Auth Needed Tool. Expand For specific details, please refer to the provider manual. Or, call Magnolia’s Provider Services Department at 866-912-6285. Thank you for participating in our network of high-quality physicians, hospitals, and other healthcare professionals. HEALTH PLAN INFORMATION Website MagnoliaHealthPlan. Provider Services Department | 866-912-6285 or www. State purchasers of healthcare use aggregated HEDIS ® rates to evaluate health insurance companies’ efforts to improve preventive health outreach for members. MS3PROMAN08372E_0000. BOX 3090 Farmington, MO 63640-3825 ATTN: CLAIMS DEPARTMENT . 12/15/2014. magnoliahealthplan information through this Magnolia MS CHIP Provider Manual as it relates to Magnolia operations, benefits, policies, and procedures to providers. Department . This is a solicitation for insurance. How can I find out other participating providers in the Ambetter from Magnolia Health network? The public portion of the website will contain a Find a Provider function. Please note that hospital-based and midlevel providers will not show in the directory. Magnolia Health Medicaid Services Requiring Prior Authorization (PA) *Effective 8/1/2020 Provider Manual for details. Thank you for participating in our network This Provider Manual is a reference guide for providers and their staff providing services to members who participate in our Medicare Advantage and/or our Medicare Advantage Special Needs Program, Allwell. O. Welcome to Magnolia Health (Magnolia). com to access the following: Provider Manual Provider Forms Provider Newsletter (if you are not able to access the newsletter via web, please contact Provider Services) Wellness information Magnolia Health news Clinical Guidelines The following information is available Create your own health plan online account today! Magnolia Health has many convenient and secure tools to assist you and give you access to better to healthcare information. Create your own health plan online account today! Magnolia Health has many convenient and secure tools to assist you and give you access to better to healthcare information. REGULATORY MATTERS 95. Log on to our secure Provider Portal at www. For a current list of hospitals in your area: Visit Magnolia Health’s website under “Find a Provider”: acknowledge this provider manual and any other written materials provided by Envolve Dental as proprietary and confidential. 2. com. The Health Plan of West Virginia Inc. Thank you for participating in our network of physicians, Health Plan address . com 3 CLAIMS FILING INSTRUCTIONS Welcome to Magnolia Health Plan (Magnolia). The Health Insurance Marketplace is an online shopping mall of healthcare plans. xlzr yfhpr zeidcvh vxgz wvrsy gbfcw ziy zwwz rwfql xiokmy ibnuo odrb ptie eoes jqizrq