Prior Authorization Tips - Non-Participating Providers Documentation Requirements

Date: 03/29/18

Magnolia Health requires that every authorization request from Non-Participating Providers is accompanied by the following:

1.       Copy of Malpractice Insurance

2.       Copy of MS Practitioner’s License

3.       Valid MS Medicaid Identification Number

4.       Completed W-9 Form (form located on the Magnolia website at www.MagnoliaHealthPlan.com)

5.       Completed Ownership & Disclosure Form (form located on the Magnolia website at www.MagnoliaHealthPlan.com)

All submissions without these documents will be rejected.