Magnolia Health Children's Health Insurance Program (CHIP) FAQs
Date: 10/16/19
1. What is changing with the Mississippi CHIP Program and why?
The Mississippi Children’s Health Insurance Program (CHIP) is currently administered by two coordinated care organizations (CCOs). New CHIP contracts with Molina Healthcare and United Healthcare Community Plan will take effect Nov. 1, 2019. After October 31, 2019, Magnolia Health plan will no longer be administering benefits for CHIP beneficiaries.
2. What happens to my provider network status with Magnolia CHIP on November 1, 2019?
Providers enrolled with Magnolia-CHIP directly or through Mississippi Physician Care Network (MPCN) will be dis-enrolled after October 31, 2019.
3. What programs will Magnolia Health continue to offer?
Magnolia will continue to reimburse claims for covered benefits for eligible members enrolled in the Medicaid MississippiCAN, Healthcare Exchange Ambetter, and Medicare Advantage Allwell.
4. Will members receive a notification of the change?
The Division of Medicaid will notify members regarding the change in CHIP CCOs through the open enrollment packets. Members will have the opportunity to choose between Molina Healthcare and United Healthcare Community Plan. If a CHIP beneficiary does not make a choice between the two CCOs, they will be automatically assigned.
5. What if I am not a CHIP provider for the other CCOs (Molina Healthcare and United Healthcare Community Plan)?
All CHIP beneficiaries that were eligible for coverage under Magnolia will be switched to one of the two coordinated care organizations (CCOs). Providers must contact Molina Healthcare and United Healthcare Community Plan regarding enrollment. The Division of Medicaid encourages providers to enroll in both CHIP CCOs.
6. Where should providers submit claims for services rendered before November 1, 2019?
Clean claims will be processed by Magnolia for services rendered before November 1, 2019 for eligible members. Claims should be submitted in accordance with the timely filing guidelines:
- Initial Magnolia-CHIP claims for dates of service prior to November 1, 2019 should be submitted within 180 days from the date of service.
- Claims reconsiderations or corrected claims should be filed within 90 days of the date of the Explanation of Payment (EOP/EOMB).
- Claim appeals should be filed within 30 days of adverse benefit determination.
7. Where should providers submit claims for services rendered on or after November 1, 2019?
Providers should submit Mississippi CHIP claims for dates of service November 1, 2019 and after to the appropriate CCO, Molina Healthcare or United Healthcare Community Plan, based on the member’s eligibility status on the date of service.
8. How will inpatient claims be reimbursed for Magnolia CHIP members admitted before November 1, 2019, and discharged after November 1, 2019?
If the member is eligible for CHIP benefits with Magnolia Health Plan on the date of inpatient admission and switches coverage to another CCO during their inpatient stay, Magnolia will process claims based on the full length of stay if the inpatient admission date is prior to November 1, 2019. Providers should always remember to check eligibility on the date of admission before providing services and obtain the appropriate authorization.
9. How will outpatient services be authorized for Magnolia CHIP members with a course of treatment or services which extend October 31, 2019?
Magnolia will authorize services that begin before November 1, 2019 through the length of service or course of treatment, which may extend beyond November 1, 2019. Prior to the expiration of Magnolia-CHIP’s authorization, the provider must contact Molina Healthcare and UnitedHealthcare and provide the authorization approval letter, in addition to any other information needed by the new CHIP CCO.
10. How will inpatient hospital stays be authorized for Magnolia CHIP members admitted before November 1, 2019, and discharged after November 1, 2019?
If a Magnolia-CHIP member is admitted prior to November 1, 2019, then the provider must obtain authorization from Magnolia Health Plan. Magnolia will conduct concurrent reviews and reimburse all covered services until discharge.
11. When will Magnolia Health Plan no longer accept or review CHIP clinical authorizations?
Magnolia will no longer review CHIP clinical authorizations beginning November 1, 2019 for enrolled members. Authorizations for dates of services which begin on or after November 1, 2019 should be submitted to the member’s assigned CCO.