Forms and Resources

Thank you for your interest in participating with Magnolia.

If you are a contracted Provider requesting to enroll a new Practitioner and/or a new location or group NPI under your existing contract, complete the following documents and email to MagnoliaCredentialing@centene.com for MSCAN, CHIP and Ambetter and MSProviderUpdates@centene.com for WellCare:

·       Provider Data Form (for Practitioners) 

·        Hospital/Ancillary Application (for Provider locations) 

*If you select multiple lines of business, you will be required to complete Magnolia’s Credentialing Application Magnolia Credentialing Application Packet

If you are a Non-contracted, Provider, you may request a contract by completing the form at the link provided below and refer to our Become a Provider page (Magnolia Health Medicaid Provider Application | Magnolia Health).

Contract Request Form 

•  Provider Care Management / Disease Management Referral Form (PDF)

• Claim Appeal Form (PDF)
• Claim Reconsideration Form (PDF)
• Claims FAQs (PDF)
• PaySpan (PDF)

• Discharge Consultation Documentation Form (PDF)
• Provider Notification of Pregnancy Form (PDF)

Dental Sedation Scoring Tool (PDF)

• EPSDT Brochure - Age 0-2 Years (PDF)
• EPSDT Brochure - Age 0-6 Years (PDF)
• EPSDT Brochure - Age 3-8 Years (PDF)
• EPSDT Brochure - Age 9-13 Years (PDF)
• EPSDT Brochure - Age 14-20 Years (PDF)
• EPSDT Brochure - Age 7-21 Years (PDF)

• Member Appeals Authorized Representative Form (PDF)

Working with Interpreters in Your Practice

Treating the whole patient – not only their conditions – is a major component of delivering quality healthcare.  Magnolia Health offers you information and tools to help make that possible. All providers (Medical, Behavioral, Pharmacy, etc.) may request interpreter services, translated materials or auxiliary aids and services. Please call 1-877-236-0751 to speak with provider services. Alternatively, you may also complete the Interpreter Request Form.

For in-person interpreter services, the request should be scheduled 5 business days in advance of the appointment to allow time for the vendors to meet the need and coordination of services with the member and provider's office. For urgent needs, we may be able to accommodate services within 2 business days. When calling in, the following information is required: 

• Member Name
• Member ID Number
• Appointment Date and Time
• Language Requested

Cancellation and rescheduling can be completed when necessary. 

Not sure of your patient’s language? Click on “Language Assistance” in the footer at the bottom of our website and have the member point to their language. If it’s not listed, you can work with the interpreter service to identify the right language.

Using the speakerphone function is recommended for communication efficiency between you, your patient and the interpreter.

Providers that use bilingual staff to communicate with patients must ensure that bilingual staff can interpret effectively, accurately, and to and from the language of the patient and English, using any necessary specialized vocabulary terminology and phraseology.

Magnolia Health (Medicaid) members speak more than 15 languages. In 2025, 94.86% of Mississippi residents reported English as their preferred language, and 2.92% prefer Spanish according to U.S. Census data.

• Adult Wellness Visit Checklist (PDF)
• Connections Referral Form (PDF)
• Foster Care Health Information Form (PDF)
• Primary Care Provider (PCP) Change Form (PDF)
• Interpreter Request Form (PDF)
• Interpreter Service FAQ (PDF)

• Pharmacy Reimbursement
• Preferred Drug List (PDL)
• Division of Medicaid Preferred Drug List Changes
• Prior Authorization Forms

• Prior Authorization List (PDF)
• Inpatient Prior Authorization Form (PDF)
• Outpatient Prior Authorization Form (PDF)
• Supplemental Prior Authorization Form (PDF)
• Prior Authorization Tips - Urgent Requests
• Prior Authorization Tips - Timeliness of Prior Authorization Requests
• Prior Authorization Tips - Doctor's Orders
• Prior Authorization Tips - Do Not Use Copies of Old PA Forms
• Prior Authorization Tips - How to Fill Out the PA Form
• Prior Authorization Tips - Removal of PA for Observation, CPAP and BiPAP
• RADMD Resources

Magnolia Health offers an electronic, fillable form for providers to request a Physician-to-Physician Peer-to-Peer discussion regarding medical necessity determinations. This process allows the requesting provider to speak directly with a Magnolia Health Medical Director to review a denied service or treatment.

Peer-to-Peer Form

• 2026 Magnolia Health MississippiCAN Provider Manual (PDF)
• 2026 Magnolia Health CHIP Provider Manual (PDF)
• Centene Dental Provider Manual (PDF)
• Centene Vision Provider Manual (PDF)

• Combined MSCAN/CHIP Appointment Availability Standards (PDF)
• How to Check Status of a Prior Authorization (PDF)

For Wellcare information, please visit our Wellcare website.

For Ambetter information, please visit our Ambetter website.