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Please contact your source of eligibility Division of Medicaid or Social Security Administration if you have a change of address.

Please contact your source of eligibility Division of Medicaid or Social Security Administration if you have a change of address.

Updated Payment Policies - Effective 9/1/2017

Date: 08/01/17

Updated Payment Policies

Effective 9/1/2017

We are happy to inform you that Magnolia Health is publishing its Payment Policies to inform providers about acceptable billing practices and reimbursement methodologies for certain procedures and services. We will apply these policies as medical claims reimbursement edits within our claims adjudication system. This is in addition to all other reimbursement processes that Magnolia Health currently employs.

Magnolia Health believes that publishing this information will help providers to bill claims more accurately, therefore reducing unnecessary denials and delays in claims processing and payments. These policies address coding inaccuracies including diagnosis to procedure code mismatch, inappropriately modified procedures, unbundling, incidental procedures, duplication of services, medical necessity requirements and health plan specific payment rules for procedures and services.

These policies are developed based on medical literature and research, industry standards and guidelines as published and defined by the American Medical Association’s Current Procedural Terminology (CPT®), Centers for Medicare and Medicaid Services (CMS), and public domain specialty society guidance, unless specifically addressed in the fee-for-service provider manual published by the state of Mississippi or regulations.

Visit https://www.magnoliahealthplan.com/providers/resources/clinical-payment-policies.html to find the Payment Policies. The effective date for the below policies is 9/1/2017.

Number

Policy Name

Policy Description

Line of Business (LOB)

CC.PP.050

E&M Medical Decision-Making

The policy discusses the appropriate assignment of moderate to high complexity E&M services with an emphasis on medical decision making as a key component of the assignment process.

Medicaid, Medicare, Ambetter

CP.MP.140

EpiFix Wound Treatment

​This policy describes the medically necessary indications for EpiFix wound treatment.

Medicaid, Medicare, Ambetter

CP.MP.139

Low-Frequency Ultrasound Wound Therapy

The policy provides a statement of medical necessity for low-frequency ultrasound wound therapy.

Medicaid, Ambetter

CP.MP.144

Mechanical Stretch Devices

This policy describes the medically necessary indications for mechanical stretching devices for joint stiffness and contracture.

Medicaid, Medicare, Ambetter

CP.MP.143

Wireless Motility Capsule

The policy provides a statement of medical necessity for wireless motility capsule (WMC).

Medicaid, Medicare*, Ambetter

CC.PP.048

Robotic Surgery

This policy defines payment criteria for robotic surgeries to be used in making payment decisions and administering benefits.

Medicaid, Ambetter

MP.PP.018

Inpatient Only Procedures- *Ambetter only*

The purpose of this policy is to serve as a reference guide on procedures that will reimbursed as inpatient only services for Ambetter only.

Ambetter

* Medicare will be implemented via prior authorization for Wireless Motility Capsule.