2020 Care Provider Manual - Mississippi Coordinated Access Network (MississippiCAN) 2020 Physician, Health Care Professional, Facility and ...
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2020
Care Provider Manual
Mississippi Coordinated Access Network
(MississippiCAN) 2020
Physician, Health Care Professional, Facility and Ancillary
Doc#: PCA-1-016518-02182020_02252020Welcome
Welcome to the Community Plan manual. This complete and up-to-date reference PDF manual allows you and your
staff to find important information such as how to process a claim and submit prior authorization requests. This manual
also includes important phone numbers and websites on the How to Contact Us page. Find operational policy changes
and other electronic tools on our website at UHCprovider.com. Click the following links to access different manuals:
• UnitedHealthcare Administrative Guide for Commercial and Medicare Advantage member information.
Some states may also have Medicare Advantage information in their Community Plan manual.
• A different Community Plan manual: go to UHCprovider.com. Click Menu on top left, select Administrative
Guides and Manuals, then Community Plan Care Provider Manuals, select state.
You may easily find information in the manual using the following steps:
1. Press CTRL+F.
2. Type in the keyword.
3. Press Enter.
If available, use the binoculars icon on the top right hand side of the PDF to search for information and topics.
If you have any questions about the information or material in this manual or about our policies, please call
Provider Services.
We greatly appreciate your participation in our program and the care you offer our members.
Important Information about the Use of this Manual
If there is a conflict between your Agreement and this care provider manual, use this manual unless your Agreement
states you should use it, instead. If there is a conflict between your Agreement, this manual and applicable federal
and state statutes and regulations and/or state contracts, applicable federal and state statutes and regulations and/
or state contracts will control. UnitedHealthcare Community Plan reserves the right to supplement this manual to help
ensure its terms and conditions remain in compliance with relevant federal and state statutes and regulations.
This manual will be amended as policies change.
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 Copyrighted by UnitedHealthcare 2020Welcome to UnitedHealthcare Community Plan
This manual is designed as a comprehensive reference source for the information you and your staff need to conduct
your interactions and transactions with us in the quickest and most efficient manner possible. Much of this material, as
well as operational policy changes and additional electronic tools, are available on our website at UHCprovider.com.
Our goal is to help ensure our members have convenient access to high-quality care provided according to the most
current and efficacious treatment protocols available. We are committed to working with and supporting you and your
staff to achieve the best possible health outcomes for our members.
If you have questions about the information or material in this manual or about any of our policies or procedures, please
call Provider Services at 877-743-8734.
We greatly appreciate your participation in our program and the care you provide to our members.
Important information regarding the use of this manual
In the event of a conflict of information between your participation agreement and this manual, the terms of this
manual will control unless the agreement dictates otherwise. UnitedHealthcare Community Plan reserves the right to
supplement this manual to ensure that its terms and conditions remain in compliance with relevant federal and state
statutes and regulations.
In addition to this reference document, information is provided to members outlining their benefits, rights, and
responsibilities at UHCprovider.com.
This manual will be amended as operational policies change.
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 Copyrighted by UnitedHealthcare 2020Table of Contents
UnitedHealthcare Community Plan Corporate Overview.................................................................................... 4
Our Approach to Health Care
UnitedHealthcare Dual Complete (HMO SNP)
How to Contact Us.................................................................................................................................................... 5
Frequently Used Information
MississippiCAN Benefits........................................................................................................................................... 8
Covered Services by Mississippi Medicaid
MississippiCAN Benefit Summary
MississippiCAN Services......................................................................................................................................... 16
NurseLineSM Services
Online Resources
Pharmacy Services
Pharmacy Prior Authorization
Prescription Limitations
Pharmacy – Preferred Drug List (PDL)
Dental
Prior Authorization
Vision
Behavioral Health and Substance Use Disorder
Medical Management............................................................................................................................................. 21
Referral Guidelines
Emergency Care
Medical ID Requirement
Prior Authorization................................................................................................................................................. 23
Determination of Medical Necessity
Disease Management
Member Identification
Health Risk Assessment
Outreach and Other Identification Processes
DM Interventions
Plan of Care
Pharmacy
Drug Utilization Review Programs
Coordination of Care
Case Management
Transition of Care
Clinical Practice Guidelines
Concurrent Review
Retrospective Review
Preventive Health Care Standards
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 1 Copyrighted by UnitedHealthcare 2020Table of Contents
Recommended Childhood Immunization Schedules
Cardiology Notification/Prior Authorization Protocol
Appeals and Grievances.................................................................................................................34
Compliance With State Requirements
Quality Management............................................................................................................................................. 40
Your Participation in Quality Management
Quality Improvement Program
Your Satisfaction
Credentialing and Recredentialing
Care Provider Responsibilities
Credentialing and Recredentialing Process
Confidentiality
HIPAA Compliance
Member Rights and Responsibilities
National Provider Identifier (NPI)
NPI Compliance
Fraud, Waste and Abuse
Definitions of Fraud, Waste and Abuse
Reporting Fraud, Waste and Abuse
Ethics and Integrity
Compliance Program
Reporting and Auditing
Claims Filing and Processing. . .............................................................................................................................. 48
Claims Billing Procedures
Electronic Data Interchange (EDI) Claims
Claims Format
Claim Processing Time
Claims Submission Rules
Payment Policies and Tools
Physician Claim-Editing Tools
Facility Claim Editing
Tax Identification Numbers/Provider IDs
Coordination of Benefits
Electronic Claims Submission and Billing
Importance and Usage of EDI Acknowledgment/Status Reports
EDI Companion Documents
e-Business Support
Span Dates
Effective Date/Termination Date
Overpayments
Subrogation
Care Provider/Member Cost Sharing Responsibilities
Timely Filing and Late Bill Criteria
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 2 Copyrighted by UnitedHealthcare 2020Table of Contents
Claim Reconsideration Requests
Care Provider Appeals
Resolving Disputes
The Correct Coding Initiative
Vaccines for Children (VFC) Billing
Member Identification Cards
Care Provider Standards and Policies.. ............................................................................................................... 57
Role of the PCP
Responsibilities of the PCP
Responsibilities of Specialists
Member Notification of Termination
Medical Residents in Specialty Practice
Standards for Appointment Scheduling
Timeliness Standards for Notifying Members of Test Results
Allowable Office Waiting Times
Care Provider Office Standards
Medical Record Charting Standards
Screening and Documentation Tools
Medical Record Review
Medical Record Documentation Standards Audit Tool
Advance Directives
Protect Confidentiality of Member Data
Care Provider Communications and Outreach.................................................................................................. 68
Care Provider Website
Care Provider Office Visits
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 3 Copyrighted by UnitedHealthcare 2020UnitedHealthcare Community Plan Corporate Overview
Medicaid contracts with UnitedHealthcare Community Plan to provide services to its Mississippi Coordinated Access
Network (MississippiCAN). As a result, we provide services to pregnant women, children and adults who meet income
requirements.
UnitedHealthcare Community Plan understands that compassion and respect are essential components of a successful
health care company. UnitedHealthcare Community Plan employs a diverse workforce, rooted in the communities we
serve, with varied backgrounds and extensive practical experience that gives us a better understanding of our members
and their needs.
Our Approach to Health Care
Innovative health care programs are the hallmark of UnitedHealthcare Community Plan. Our personalized programs
encourage the utilization of services. These programs, some of them developed with the aid of researchers and clinicians
from academic medical centers, are designed to help our chronically ill members avoid hospitalizations and hospital
emergency room visits — in short, to live healthy, productive lives.
The unique UnitedHealthcare Community Plan Personal Care Model™ features direct member contact by our clinicians
trained to foster an ongoing relationship between the health plan and members suffering from serious and chronic
conditions. The goal is to use high-quality health care and practical solutions to improve members’ health and keep them
in their communities — with the resources necessary to maintain the highest possible functional status.
UnitedHealthcare Community Plan does not require or request you to enter into an exclusive relationship with us or any
of our business affiliates.
UnitedHealthcare Dual Complete (HMO SNP)
For information about UnitedHealthcare Dual Complete, please see Chapter 4 of the Physician, Health Care
Professional, Facility and Ancillary Provider Administrative Guide for Commercial and Medicare Advantage Products. For
state-specific information, go to UHCprovider.com > Menu >Health Plans by State.
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 4 Copyrighted by UnitedHealthcare 2020How to Contact Us
UHCprovider.com To review a patient’s eligibility or benefits,
check claims status, submit claims or
review Directory of Physicians, Hospitals
and other Health Care Professionals.
Provider Services 877-743-8734 This is an automated system. Please have
your National Provider Identifier number and
Hours of Operations:
your tax ID or the member ID ready, or you
Monday – Friday 8 a.m. to 5 p.m.
may hold to speak to a representative. The
call center is available for you to:
• Answer general questions
• Verify member eligibility
• Check status of claims
• Ask questions about your participation
or notify us of demographic and practice
changes
Prior Authorization 866-604-3267 To request prior authorization or to notify us
Notification in accordance with the prior authorization/
Fax 888-310-6858
notification requirements section of this
UHCprovider.com guide.
Pharmacy Services 877-305-8952 OptumRx
Pharmacy Help Desk
Available 24 hours a day, 7 days a week
Behavioral UBH Customer Service:
Health Services 866-673-6315
Prior Authorization:
877-743-8731
Provider Services:
877-743-8734
Dental 800-508-4862
Vision 844-606-2724
Hospital Inpatient Services 866-604-3267
and Concurrent Reviews Fax 888-310-6858
Transportation 844-525-2331
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 5 Copyrighted by UnitedHealthcare 2020How to Contact Us
MississippiCAN Care Provider UHCprovider.com
Verify member eligibility, check status of claims, submit claim
adjustment requests.
Frequently Used Information Provider Services: 877-743-8734
This is an automated system. Please have your National Provider
Identifier number and your Tax ID or the member ID ready, or you
may hold to speak to a representative. The call center is available for
Our Claims Process Complete Claims you to:
To help ensure prompt payment: A complete claim includes the following:
• Ask questions about benefits.
Review and copy both sides of the • Member’s name, date of birth, address and ID number.
• Verify member eligibility.
1 member’s ID card. UnitedHealthcare • Name, signature, address and phone number of physician or care
Community Plan members receive an ID • Check claim status.
provider performing the service, as in your contract document.
card containing information that helps you • Ask questions about your participation or notify us of demographic
• National Provider Identifier (NPI) number.
process claims accurately. These ID cards and practice changes.
display information such as claims address, • Physician’s or care provider’s tax ID number.
• Request information regarding credentialing.
copayment information (if applicable), • CPT-4 and HCPCS procedure codes with modifiers where
and telephone numbers such as those for Prior Authorization: 866-604-3267
appropriate.
member and care provider services. Available Monday – Friday 8 a.m. – 5 p.m. (CT), 24 hours for
• ICD-10 diagnostic codes. emergency. For a complete and current list of prior authorizations,
Notify UnitedHealthcare Community Plan’s
2 • Revenue codes (UB-04 only). go to UHCprovider.com/priorauth.
Health Services of planned procedures and
Fax prior authorizations to 888-310-6858
services on the Prior Authorization list. • Date of service(s), place of service(s) and number of services
(units) rendered. Utilization Management: 877-743-8731
Prepare a complete and accurate electronic
3 Staff is available Monday through Friday, 8 a.m. to 5 p.m. (ET), to
or paper claim form (see “Complete claims” • Referring physician’s name (if applicable). assist with routine prior authorizations, admissions, discharges and
at right). Complete a CMS 1500 or UB-04
• Information about other insurance coverage, including job- coordination of members’ care. On-call staff is available 24/7 for
form.
related, auto or accident information, if available. emergency prior authorization purposes.
Submit claims electronically to reduce
4 • Attach operative notes for claims submitted with modifiers 22, Case Management: 877-743-8731
costs, help ensure faster processing
62, or any other team surgery modifiers. Disease Management: 877-743-8731
and reduce claim entry errors. Use our
electronic payer (ID 87726) to submit • Attach a description of the procedure/service provided for Pharmacy Prior Authorization:
claims to us. For more information, contact claims submitted with unlisted medical or surgical CPT codes or Go to UHCprovider.com/priorauth for a copy of the pharmacy
your vendor or our Electronic Data experimental or reconstructive services (if applicable). provider authorization form. Call 800-310-6826 or fax pharmacy
Interchange (EDI) unit at 800-210-8315. If prior authorization to 866-940-7328
you do not have access to internet services, Injectable drugs provided in an office/clinic setting:
you can mail the completed claim to: Vision: 800-877-7195
The health plan will be responsible for reimbursement of injectable
drugs obtained in an office/clinic setting and to care providers Transportation: 844-525-2331
UnitedHealthcare Community Plan
providing both home infusion services and the drugs and biologics. Behavioral Health
PO Box 5032
The health plan will require that all professional claims contain BH Claims: 866-673-6315
Kingston, NY 12402-5032
NDC (National Drug Code) 11-digit number and unit information to BH Prior Authorization: 877-743-8731
be paid for home infusion and J codes. The NDC number must be
entered in 24D field of the CMS-1500 Form or the LIN segment of Member Services Helpline: 877-743-8731
the HIPAA 837 electronic form. Services reimbursed by the health Available to answer member calls Monday through Friday, 8 a.m. to
plan will not be included in any pharmacy benefit limits established 6 p.m. (CT). In addition, our interactive voice response (IVR) telephone
for pharmacy services. system is available 24 hours a day, 7 days a week, and our nurse
triage hotline is available through our IVR for health-related issues.
6MississippiCAN
MississippiCANCare Provider
Care Provider
Frequently Used Information
Quick Reference Guide
Other
OtherImportant
ImportantInformation
Information Notify UnitedHealthcare’s
NotifyUnitedHealthcare Health
Community Plan’s Health
Claim Reconsideration
ClaimReconsideration Request
Request Services
ServicesWithin the Following
Within Time Frames:
the Following Time Frames:
UnitedHealthcareOnline.com > Claims and
UHCprovider.com/claims > Claims Reconsiderations
Non-Emergency
Non-Emergency Care (except
Care maternity)
(except maternity)
Payments > Claims Reconsiderations
Claim mailing address At
Atleast
leastfive business
five days
business days to non-emergent,
priorprior non-urgent
to non-emergent, hospital
non-urgent admissions and/or outpatient
hospital
P.O. Box 5032 services.
admissions and/or outpatient services.
Claim mailing address
Kingston,
P.O. Box NY 12402-5032
5032 Emergency
Emergency Care:
Care:
Kingston, NY 12402-5032 Urgent
Urgentororemergent admissions
emergent admissionsdo not require
do not a prior
require authorization.
a prior HOWEVER,
authorization. Urgent/Emergent
HOWEVER, Urgent/Emergent
Fraud and Abuse Division for
Anonymous Reporting: 866-242-7727 inpatient
inpatientadmissions
admissions require
dodo notification
require within
notification 24 hours
within of admission.
24 hours of admission.
Fraud and Abuse Division: 866-242-7727
(Mon-Fri 8:00 a.m. – 4:30 p.m. Central)
(Mon-Fri 8:00 a.m. – 4:30 p.m. Central) Return
Returncalls from
calls health
from service
Health coordinators
Service and medical
Coordinators anddirectors
Medicaland
Directors
provide and provide complete
UnitedHealthcare
UnitedHealthcare Online
Online Support
Support Services:
Services: complete health information
health information withinwithin one business
one business day.day.
UnitedHealthcareOnline.com
UHCprovider.com
HelpDesk: 866-842-3278
HelpDesk:866-842-3278
Pharmacy
Pharmacy NPI Compliance
NPI Compliance Medicaid Requirement
MedicaidIDID Requirement
• Preferred Drug List (PDL) National Provider Identification You be enrolled in Mississippi Medicaid and
National Provider Identification
(NPI)(NPI) Please
mustnote that all care providers must be enrolled
have a in
Preferred Drug List (PDL)
•877-743-8734 Federal Regulations and many state Medicaid agencies state Medicaid ID be reimbursed for services
877-743-8734 Mississippi
providerMedicaid, and
to have a state provider
UHCprovider.com/MSCommunityPlan >Pharmacy Federal regulations
require and many
the use of your National
stateProvider agencies require
MedicaidIdentifier, NPI, onthe
all provided a MississippiCAN member.
UHCCommunityPlan.com MedicaidtoID in order to be reimbursed for services
Resources and Physician Administered Drugs > electronic NPI on
use of yourand all electronic
paper and paper claim
claim submissions submissions.
effective May 23, provided to a MississippiCAN member.
•Prescription
Pharmacy Drug
PriorLists, Drug Search and Updates
Authorization 2008. Therefore,
Therefore, you must you
include
mustainclude valid
valid NPIaon all claims
NPI onsubmitted
all claimsto An enhanced claim denial edit helps ensure that no
800-310-6826 submitted
us for payment.
to usTofor payment.
assist us in expediting
To assistthis in expediting
us process, pleasethis
also payments are made to care providers without a Mississippi
• Pharmacy Prior Authorization
UHCCommunityPlan.com process, please
include your name,also include
address, andyour
TIN. provider name, address, An enhanced
Medicaid ID, on claim denial
file. If your edit ensures
claims have denied
thatdue
no to
800-310-6826 and TIN. payments are made to providers without a Mississippi
missing Medicaid ID, and you have a current Mississippi
• Pharmacy (OptumRx) Technical Help Desk
UHCprovider.com/MSCommunityPlan >Pharmacy If you have not yet applied for and received your NPI, please do Medicaid ID on file. If your claims have denied due to
Medicaid ID, contact Provider Services at 877-743-8734.
877-305-8952
Resources and Physician Administered Drugs > immediately
Ifsoyou have not by
yetvisiting
appliednppes.cms.hhs.gov. you have
for and receivedIfyour NPI, not
please missing Medicaid ID and you have a current
We will update your records and adjust applicable claims.
•Pharmacy Pharmacy
NetworkPrior Locator
Authorization do
yetsoprovided your NPI
immediately us, please
bytovisiting do so immediately by
nppes.cms.hhs.gov. going
If you to
have Mississippi Medicaid ID, please contact Provider
UHCCommunityPlan.com
UHCprovider.com
not and choose
yet provided your NPI toNational Provider
us, please do soIdentifier
immediately
from by IfServices hotline
you do not have at 877-743-8734
a current Mississippiso
Medicaid
that weID,can
a
• Pharmacy (OptumRx) Technical Help Desk the Most
going Visited section. Downloadable forms
to UnitedHealthcareOnline.com and are
choose website
on theNational facilitate
care updating
provider enrollment records and
your application canadjusting
be found at
877-305-8952 for you. NPI
Provider information
Identifier fromcanthealso
Most
be Visited
faxed tosection. There are applicable claims.
ms-medicaid.com/msenvision.
downloadable 414-721-9006.
866-455-4068 orforms on the website for you fill in the
• Network Pharmacy Locator
UHCCommunityPlan.com/MS > MississippiCAN > appropriate information. NPI information can also be faxed to If you do not have a current Mississippi Medicaid ID,
866-455-4068
You must provideor UnitedHealthcare Community Plan the NPI
to414-721-9006.
Plan Details > Pharmacy Search a provider Enrollment application can be found at:
that aligns with your MS Medicaid ID. Failure to do so may impact
msmedicaid.acs-inc.com/msenvision/index.do
claims payment.
Please note that all care providers must provide to
UnitedHealthcare the NPI that aligns with their MS Medicaid
ID. Failure to do so may impact claims payment.
7
7 Community PlanMississippiCAN Benefits
Covered Services by
Mississippi Medicaid
Federally Mandated Covered Services: State-Covered Optional Services:
• EPSDT and Expanded EPSDT Services • Ambulatory Surgical Center Services
• Family Planning Services • Behavioral Health Services
• Federally Qualified Health Centers Services • Chiropractic Services
• Home Health Services • Christian Science Sanatoria Services
• Inpatient Hospital Services • Dental Services
• Laboratory and X-Ray Services • Disease Management Services
• Nurse Midwife Services • Durable Medical Equipment
• Nurse Practitioner Services (Pediatric and Family) • Eyeglasses
• *Nursing Facility Services • Freestanding Dialysis Center Services
• Outpatient Hospital Services • Hospice Services
• Physicians Services • Intermediate Care Facility for Individuals with
• Rural Health Clinic Services Intellectual Disabilities (ICF/IID) Services
• Transportation Services • Inpatient Psychiatric Services
• Physical Therapy
• Occupational Therapy
• Pediatric Skilled Nursing Services
• Podiatrist Services
• Prescription Drugs
• Psychiatric Residential Treatment Facilities Services
• Speech Therapy
• State Department of Health Clinic Services
• Targeted Case Management Services for Children
With Special Needs
• Long-Term Acute Care (LTAC) for Children
All benefits are subject to change at the
discretion of Mississippi Medicaid.
For more comprehensive information on
benefits, please visit the website at
medicaid.ms.gov.
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 8 Copyrighted by UnitedHealthcare 2020MississippiCAN Benefit Summary
The following table includes benefits, limitations, prior authorization information and additional notes. Link is the preferred
method to request prior authorization. Prior authorization is not a guarantee of payment. Find the most current prior
authorization requirements at UHCprovider.com/MSCommunityPlan > Prior Authorization and Notification Resources.
Benefit Limitation Prior Authorization* Notes
Ambulatory Surgical Center Not required
Services
Ambulance Services Emergency: not required
Non-emergency and fixed-wing
requires prior auth:
ph: 866-604-3267
fax: 888-310-6858
Non-Emergency Limited to Medicaid-covered Three days’ notice required by Requests must be made at least
Transportation Services services only. Excluded if service calling Member Services at: three business days in advance.
limits have been met. Excluded 877-743-8731
if beneficiary has transportation
resources
Chiropractic Services $700 maximum per calendar year Not required
Christian Science Sanitoria Not required
Services
Cosmetic and Reconstructive Yes
Surgery- Outpatient ph: 866-604-3267
fax: 888-310-6858
Dialysis Outpatient Center Not required
Services
Durable Medical Equipment Medicaid policy restrictions apply Yes. Prior authorization required Additional DME information can
(DME) for items more than $500. be found at: medicaid.ms.gov
ph: 866-604-3267
fax: 888-310-6858
Medical Supplies Maximum of six diapers/ Yes for more than six diapers/ Medicaid provides one month
underpads per day for ages three underpads per day for ages three supply at a time
and up with medical condition and up
causing incontinence of bowel
ph: 866-604-3267
and/or bladder
fax: 888-310-6858
EPSDT† Limited to beneficiaries younger Not required
than 21
Expanded EPSDT Services‡ Limited to beneficiaries younger Not always required Prior authorization may be
than 21 required to determine medical
necessity
Family Planning Services Not required
Federally Qualified Health Not required
Center Services
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 9 Copyrighted by UnitedHealthcare 2020Benefit Limitation Prior Authorization* Notes
Genetic Testing Yes
ph: 866-604-3267
fax: 888-310-6858
Health Department Services Not required Includes certain pharmacy
services through MS State Dept.
of Health (MSDH), Early
Intervention Program (EIP),
Perinatal High Risk Management/
Infant Services (PHRM/ISS)
Hearing Services Hearing tests are covered. Required for any services beyond For more information, please see
EPSDT-covered services and all the MS CAN prior authorization
Hearing aids are limited to
hearing aids listed on the prior list at UHCprovider.com/
beneficiaries under 21 years of age
authorization requirements list MSCommunityPlan > Prior
Authorization and Notification.
ph: 866-604-3267
fax: 888-310-6858
Home Health Services Children - unlimited Yes This does not apply to physical,
Adults - 25 visits per ph: 866-604-3267 occupational, speech therapies,
calendar year fax: 888-310-6858 DME, orthotics, or prosthetics.
See those sections for additional
information
Home Infusion Certain medications may require Medicaid preferred drug list can
prior auth. depending on Medicaid be accessed: medicaid.ms.gov
preferred drug list
Hospice Limited to diagnoses that include Yes Provides benefits for Hospice
-Inpatient six months or less life expectancy ph: 866-604-3267 Services unless concurrent of an
-Outpatient as certified by physician fax: 888-310-6858 inpatient stay
Hospital Services Required for admissions To request authorization online:
-Inpatient Days ph: 866-604-3267 UHCprovider.com/priorauth
-Long-Term Acute Care (LTAC) fax: 888-310-6858
for Pediatrics
Not required for emergency
-Emergency Dept
services
Hysterectomy For age 21 years and older Yes Medicaid consent required and
ph: 866-604-3267 can be accessed: medicaid.
fax: 888-310-6858 ms.gov/resources/forms/
Imaging Yes Additional information:
ph: 866-604-3267
-Nuclear Studies UHCprovider.com/
fax: 888-310-6858
-Computed Tomography (CT, MSCommunityPlan > Prior
SPECT Scans) Online authorization: carriers. Authorization and Notification >
-Magnetic Resonance carecorenational.com/ Radiology Prior Authorization and
(MRI, MRA) PreAuthorization/screens/ Notification Program
-PET Scans login.aspx
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 10 Copyrighted by UnitedHealthcare 2020Benefit Limitation Prior Authorization* Notes
Laboratory Not required
Non-Contracted Care Provider Yes Care provider and/or outpatient
Services (Outpatient Facility & ph: 866-604-3267 facility services are payable only
Professional) fax: 888-310-6858 with prior authorization
Nurse Practitioner Services Not required
Nursing Facility Services Yes Services are not administered by
Benefits provided through Division UnitedHealthcare Community Plan
of Medicaid. although member is entitled to all
Medicaid benefits
Orthotics and Prosthetics Limited to beneficiaries under 21 Yes. Prior authorization required Medicaid does not cover
years of age. for items more than $500 treatment for flat feet (including
arch supports) for adults 21 and
Coverage does not include arch
older so it is not covered service
supports ph: 866-604-3267
fax: 888-310-6858
Outpatient Physical and Required for services provided by These benefits are not covered
Occupational Therapies home health agencies (see Home through the home health program
(PT, OT) Health Services). for beneficiaries 21 and older
ph: 866-604-3267
fax: 888-310-6858
Skilled Nursing and Private Limited to beneficiaries younger Yes
Duty Nursing Services than 21 ph: 866-604-3267
fax: 888-310-6858
Perinatal High Risk Not required
Management Services
Physician Assistant Services Not required
Physician Services for 36 visits per year Yes Services are not administered
Long-Term Care Visits Benefits provided through Division by UnitedHealthcare Community
of Medicaid. Plan, although member is entitled
to all Medicaid benefits
Physician Services in Medical Not required
Offices (Primary and Specialty
Care)
Podiatrist Services Not required
Prescribed Pediatric Extended Limited to beneficiaries younger Yes
Care (PPEC) than 21 ph: 866-604-3267
fax: 888-310-6858
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 11 Copyrighted by UnitedHealthcare 2020Benefit Limitation Prior Authorization* Notes
Prescription Drugs Members are limited to six Yes for beneficiaries younger than Medications can be dispensed
prescription drugs per month, with 21 if therapy exceeds limitations. as an emergency 72-hour supply
no more than two of the six being ph: 800-310-6826 when drug therapy must not be
brand-name, non-preferred drugs. fax: 866-940-7328 delayed and prior-authorization
is not available. This applies to
Beneficiaries younger than 21 can Note that some drugs on the
non-preferred drugs and any
receive more than the monthly preferred drug list (PDL) may still
drug affected by a need for prior
limit with a medical necessity prior require prior authorization
authorization.
authorization
See: UHCprovider.com/
MSCommunityPlan >
Pharmacy Resources and
Physician Administered Drugs
> Prescription Drug Lists, Drug
Search and Updates
Rural Health Clinic Services Not required
Sleep Studies Yes
ph: 866-604-3267
fax: 888-310-6858
Speech Therapy (SLP) Yes. Speech therapy requires
authorization in an outpatient
setting.
ph: 866-604-3267
fax: 888-310-6858
Sterilization For members 21 and older Yes Medicaid consent required and
ph: 866-604-3267 can be accessed: medicaid.
fax: 888-310-6858 ms.gov/resources/forms/
Surgery (Inpatient) Yes
ph: 866-604-3267
fax: 888-310-6858
Transplant Services Yes Human solid organ (heart, lung,
ph: 866-604-3267 liver, kidney) or bone marrow/stem
fax: 888-310-6858 cell transplants are covered with
prior authorization.
Eye Care Benefit Limitation Prior Authorization* Notes
Children Two exams per year Required only for second pair of
-Examination glasses within the year
Two pairs of glasses per year
-Glasses
ph: 844-606-2724
Adults One exam per year Not required
-Examination
One pair of glasses every three
-Glasses
years
Dental Benefit Limitation Prior Authorization* Notes
Children $2,500 maximum per calendar Required for procedures such as Included:
year for dental unless prior crowns, root canals, orthodontics Preventive
authorization is obtained Diagnostic
ph: 800-508-4862
Restorative
$4,200 maximum per lifetime per
Orthodontia
child
Emergency pain relief
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 12 Copyrighted by UnitedHealthcare 2020Dental
Benefit
Benefit Limitation Prior Authorization* Notes
Adults $2,500 maximum per calendar Required for procedures such as Included:
year for dental unless prior crowns, root canals, orthodontics Diagnostic
authorization is secured Emergency pain relief
ph: 800-508-4862
Orthodontics is not covered
for adults
Mental Health Benefit Limitation Prior Authorization* Notes
Community Mental Health Yes for some services. Refer to
Center (CMHC) Services the most recent PA list.
ph: 866-604-3267
fax: 888-310-6858
Intermediate Care Facility for Therapeutic leave days limited to No Beneficiaries must be deemed
Individuals with Intellectual 90 days per year eligible by MS Division of Medicaid
Disabilities (ICF/IID) Inpatient to receive these services
Services
Inpatient Psychiatric Services Yes Available for children, adolescents
and adults. Care management is
ph: 866-604-3267
also available by calling 877-743-
fax: 888-310-6858
8731.
Physician Psychiatry Services Generally, basic physician services
do not require PA. However, please
consult the most recent PA list for
a comprehensive list of services
which do require PA.
ph: 877-743-8731
Psychiatric Residential No
Treatment Facilities (PRTF)
Psychological Evaluation Yes
and Testing by Licensed
ph: 866-604-3267
Psychologist
fax: 888-310-6858
Therapeutic and Evaluative Generally, these services do not
Mental Health Services for require PA. However, please
Children consult the most recent PA list for
a comprehensive list of services
which do require PA.
*Prior authorization is initiated by the care provider performing the requested services. Prior authorization information
is accurate only at the time of print, and is subject to change. You should always consult the most recent PA list found at
UHCprovider.com/MSCommunityPlan.
† EPSDT Services can only be performed by a care provider certified by the MS Division of Medicaid.
Services include:
●● a comprehensive unclothed physical exam
●● comprehensive family/medical/developmental history
●● immunization status, any shots that are needed
●● lead assessment and testing
●● necessary blood and urine screening
●● tuberculosis (TB) skin test
●● developmental assessment
●● nutritional assessment/counseling
●● adolescent counseling
●● vision testing/screening
●● hearing testing/screening
●● dental referral services
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 13 Copyrighted by UnitedHealthcare 2020Benefit Exclusions
●● Items or services furnished gratuitously, without regard to the individual’s ability to pay and without expectation of payment
from any source, such as free X-rays provided by a health department.
●● Any operative procedure, or any portion of a procedure, performed primarily to improve physical appearance and/or treat a
mental condition through change in bodily form.
●● Routine physical examinations, such as school, sports, or employment physicals that are not part of the well-child screening
program for beneficiaries younger than 21 years or are not covered.
●● Services of physical therapist or speech therapist are not covered for Medicaid beneficiaries 21 or older, except when
provided as an outpatient hospital service, or as a nursing facility service. Therapy services are not covered in a nursing
facility when performed by a home health agency.
●● Prosthetic and orthotic devices, and orthopedic shoes for beneficiaries 21 or older, except for crossover claims allowed by
Medicare.
●● Vitamin injections, except for B-12 as specific therapy for conditions determined to be medically necessary and specifically
covered by Medicaid.
●● Prescription vitamins and mineral products are excluded except for prenatal vitamins and folic acid for obstetrical patients.
(Medically necessary nutritional supplements may be covered and are subject to inclusion criteria. See prior authorization
requirements to determine medical necessity.)
●● Routine circumcisions for newborn infants.
●● Interest on late pay claims.
●● Acute freestanding psychiatric facilities for beneficiaries 21 and older.
●● Reimbursement for services provided to only Qualified Medicare Beneficiaries (QMB) except for Medicare/Medicaid
crossover payments of Medicare deductibles and coinsurance.
●● Medicare deductibles and coinsurance will not be paid for QMBs in non-Medicaid eligible facilities.
●● Reimbursement for any Medicaid service for Specified Low-income Medicare Beneficiaries (SLMB) and Qualified
Individuals (QI). These individuals are entitled only to payment or partial payment of their Medicare Part B premium.
●● Ambulance transport to and from dialysis treatment.
●● Reversal of sterilization, artificial or intrauterine insemination and in vitro fertilization.
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 14 Copyrighted by UnitedHealthcare 2020Benefit Exclusions
●● Services, procedures, supplies or drugs which are still in clinical trials and/or investigative or experimental in nature.
●● Routine foot care in the absence of systemic conditions.
●● Gastric surgery (any technique or procedure) for the treatment of obesity or weight control.
●● Telephone contacts/consultations and missed or cancelled appointments.
●● Wigs.
●● Services ordered, prescribed, administered, supplied or provided by an individual or entity that has been excluded by
DHHS.
●● Services ordered, prescribed, administered, supplied or provided by an individual or entity that is no longer licensed by their
governing board.
●● Services outside the scope and/or authority of a practitioner’s specialty and/or area of practice.
●● Services not specifically listed or defined by Medicaid are not covered.
●● Any exclusion listed elsewhere in the Mississippi Medicaid Provider Policy Manual, bulletins, or other
Mississippi Medicaid publications. This includes:
– Drugs that are investigational or approved for investigational purposes,
– Drugs used for off-label indications not found in official CMS-approved compendia or generally accepted in
peer-reviewed literature
Acronyms
MH - Mental Health
MS - Medical Services
NET - Non-Emergency Transportation
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 15 Copyrighted by UnitedHealthcare 2020MississippiCAN Services
NurseLineSM Services Ask medication questions.
●● Learn how to take medication safely and avoid
Helping our members to make confident health care
interactions.
decisions.
Members can call a NurseLine nurse any time for health
Coping with health concerns can be time-consuming
information and support — all at no cost — at
and complex. With so many choices, it can be hard to
877-370-4009. Health Information Library Pin Number:
know where to look for trusted information and support.
466.
That’s why NurseLine services were developed — to
give our members peace of mind with:
Online Resources
●● Immediate answers to health questions any time,
from anywhere — 24 hours a day at 877-370-4009 Members also have access to a wealth of information
Health Information Library Pin Number: 466; online. Members can visit UHCCommunityPlan.com
for health and well-being news, tools, resources and
●● Access to caring registered nurses who have an
more. Members can even chat with a nurse any time
average of 15 years clinical experience; and
about health questions or concerns.
●● Trusted, care provider-approved information to
guide health care decisions.
Pharmacy Services
When a member calls, a caring nurse can help our
members to: The following drugs and medical supplies are covered:
Choose appropriate medical care. (a) L egend drugs (federal law requires these drugs be
dispensed by prescription only). These drugs are
●● Understand a wide range of symptoms; manufactured by companies who have a signed
●● Determine if the emergency room, a doctor visit or drug rebate agreement. The Division of Medicaid
self-care is right for their needs; and its contractors are not required to cover
prescription drugs from manufacturers that do not
Find a doctor or hospital. participate in the federal drug rebate program;
●● Find doctors or hospitals that meet their needs and (b) Compounded medication of which at least one
preferences; ingredient is a legend drug;
●● Locate an urgent care center and other health (c) Disposable blood glucose testing agents;
resources.
(d) Disposable insulin needles/syringes;
Understand treatment options. (e) Growth hormones;
●● Learn more about a diagnosis; (f) Insulin;
●● Explore the risks, benefits and possible outcomes (g) Lancets;
of treatment options;
(h) Legend contraceptives;
Achieve a healthful lifestyle. (i) Retin-A (tretinoin topical);
●● Get tips on how nutrition and exercise can help the (j) Smoking deterrent medications containing nicotine
member maintain a healthful weight. or any other smoking cessation aids, all dosage
●● Learn about important health screenings and forms (e.g., Nicorette, NicoDerm).
immunizations;
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 16 Copyrighted by UnitedHealthcare 2020The following are excluded: one year after the date of practitioner’s original
prescription.
(a) Anabolic steroids (e.g., Winstrol, Durabolin);
(b) Anorectics (any drug used for the purpose of Pharmacy Prior Authorization
weight loss) with the exception of Dexadrine and
Adderall for Attention Deficit Disorder; Medications can be dispensed as an emergency
72-hour supply when drug therapy must start without
(c) A
nti-wrinkle agents (e.g., Renova); delay and prior authorization is not available. The rules
(d) C
harges for the administration or injection of any apply to non-preferred drugs on the PDL and to any drug
drug; that is affected by a clinical prior authorization edit.
(e) Dietary supplements; To request pharmacy prior authorization, please call the
OptumRx Pharmacy HelpDesk at 800-310-6826 or fax
(f ) I nfertility medications (e.g., Clomid, Metrodin, your authorization request to 866-940-7328.
Pergonal, Profasi);
Prior authorization requests are reviewed and notification
(g) Minerals (e.g., Potaba); is sent back within 24 hours.
(h) M
edications for the treatment of alopecia, e.g.
(Rogaine); Prescription Limitations
(i) N
on-legend drugs other than those listed as All Medicaid beneficiaries are limited to six prescriptions
covered; per month with no more than two being brand-name
drugs, including refills. Preferred brands do not count
(j) Pigmenting/de-pigmenting agents; toward the monthly brand service limit, but do count
(k) Drugs used for cosmetic purposes; towards the drug service limit of six per month.
(l) Therapeutic devices or appliances, including Children younger than 21 can receive more than the
needles, syringes, support garments and other monthly prescription limits with a medical necessity prior
non-medicinal substances, regardless of intended authorization. Requests for these exceptions should be
use, except those listed as covered, such as insulin made either in writing by the prescriber and faxed to
needles and syringes; 866-940-7328, or called into UnitedHealthcare
Community Plan’s Pharmacy Prior Authorization Services
(m) Any medication not proven effective in general at 800-310-6826. A prior authorization request form is
medical practice; available at UHCprovider.com/MSCommunityPlan >
Pharmacy Resources and Physician Administered Drugs
(n) I nvestigative drugs and drugs used other than for > Pharmacy Prior Authorization, and should be used for
the FDA-approved diagnosis; all prior authorization requests if possible.
(o) Drugs that do not require a written prescription;
(p) C
ertain prescription drugs if an equivalent product Pharmacy - Preferred Drug List (PDL)
is available over the counter. This exclusion does
The Division of Medicaid (DOM) determines and
not apply to drugs on the Medicaid preferred drug
maintains its Universal Preferred Drug List (PDL). This list
list; and
applies to all MississippiCAN beneficiaries.
(q) R
efills in excess of the number specified by the
For Medicaid beneficiaries, you are required to prescribe
practitioner or any refills dispensed more than
preferred drugs listed on the Universal PDL. For drugs
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 17 Copyrighted by UnitedHealthcare 2020not listed on the Universal PDL, Mississippi law requires f. Sealants – covered through age 20 for permanent
the DOM not reimburse for a brand-name drug if an first and second and pre-molars, one per every
equally effective generic equivalent is available and is five years. Sealants on primary teeth with prior
the least costly. The same applies to UnitedHealthcare authorization.
MississippiCAN members. If a non-preferred medication
is required for a member’s treatment, call the Pharmacy 2. Benefits are also provided for restorative, endodontic,
Prior Authorization Service at 800-310-6826, or fax a periodontic and surgical dental services as indicated:
Pharmacy Prior Notification Request form to
a. Amalgam, composite, sedative, and composite
866-940-7328 to make the request. The request will be
resin fillings including the replacement of an
promptly reviewed. You will be notified of the decision.
existing restoration;
PDL information, including updates of when changes
b. Stainless steel crowns on posterior and anterior
occur, will be provided to you in advance, and a summary
primary teeth when amalgam and composite
of changes posted to the plan’s website. We fax advanced
restoration are insufficient;
notifications to you approximately one month before the
changes become effective. You also have the option to c. Porcelain crowns to anterior teeth only;
contact us for a list of your patients who are impacted by
any PDL change. The PDL and Pharmacy Prior Notification d. Simple and surgical extraction;
Request form can be found on the plan’s website at
e. Extraction of symptomatic impacted teeth;
UHCprovider.com/MSCommunityPlan > Pharmacy
Resources and Physician Administered Drugs. To obtain a f. Pulpotomy, pulpectomy and root canal;
print copy of the PDL, contact the Provider Service Center.
g. Gingivectomy, gingivoplasty and gingival curettage,
periodontal scaling and root planing once per
Dental quadrant per fiscal year.
1. Benefits are provided for preventive and diagnostic 3. Orthodontic Treatment - Orthodontic services are
dental care as recommended by the American restricted to Medicaid-eligible beneficiaries younger
Academy of Pediatric Dentistry (AAPD). The than 21.
following Covered Dental Services are limited to
$2,500 per fiscal year maximum (July 1-June 30): UnitedHealthcare Community Plan will consider
orthodontic authorization requests for beneficiaries
a. Bitewing X-rays as needed but no more frequently through age 20 who meet at least one of the
than one per fiscal year (July 1-June 30); following pre- qualifying criteria:
(b. C
omplete mouth X-ray and panoramic X-ray – as ●● Cleft lip, cleft palate and other craniofacial
needed, but no more frequently than once every anomalies;
24 months; ●● Overjet of 9 millimeters or more;
c. P
rophylaxis- two times every fiscal year (July 1- ●● Reverse overjet of 2 millimeters or more;
June 30) and must be at least five months apart; ●● Extensive hypodontia with restorative implications
(more than one tooth per quadrant) requiring pre-
d. Fluoride Treatment – two times every fiscal year (July prosthetic orthodontics;
1-June 30) and must be at least five months apart;
●● Anterior openbites greater than 4 millimeters;
e. S pace Maintainers – limited to permanent teeth ●● Upper anterior contact point displacement with
through age 20; greater than four millimeters;
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 18 Copyrighted by UnitedHealthcare 2020●● Individual anterior tooth cross bites with greater UnitedHealthcare Community Plan’s contracted
than a 2-millimeter discrepancy between ophthalmologists as listed in the UnitedHealthcare Community
retruded contact position and intercuspal Plan Provider Directory. If medical eyecare is needed, please
position. For all orthodontic services, the member refer patients to a participating ophthalmologist.
must complete the course of treatment by their
21st birthday. Approved cases subject to a lifetime Prior Contact for
Benefit Limitation
maximum for orthodontic services of $4,200. Auth Prior Auth
Adults age 21 and older have emergency dental benefits, Eyecare (Eye Children – two Yes, for Member’s
exams and eye exams per children after selected
some limitations and prior authorizations apply.
glasses) fiscal year, one first pair per March® Vision
pair eyeglasses fiscal year Provider or
per fiscal March® Vision
Prior Authorization year, plus one directly by
additional pair calling
Prior authorization or other limitations may apply for some eyeglasses 844-606-2724
covered
dental services such as crowns, periodontal or specific under repair/
oral surgery procedures, and orthodontic treatment. replacement
Please contact Dental Provider Services for specific coverage per
fiscal year
information at 800-508-4862.
Adults – one
eye exam per
Vision fiscal year, one
pair eyeglasses
Routine vision, which includes a comprehensive eye every three
fiscal years
exam and glasses or contacts, is provided through our
third-party vendor, MARCH® Vision Care. Additionally,
the March® Vision network of ODs and MDs provide Behavioral Health and
primary eyecare services. The vision plan provides
supplemental coverage for non-surgical medical eyecare Substance Use Disorder
through a March® Vision doctor. Examples of services Members have statewide access for outpatient behavioral
covered include diagnosis and tests for loss of vision, health and substance use disorder (SUD) services.
treatment for conditions such as conjunctivitis (pink eye), Out‑of‑state services are limited to specific emergency
and management of glaucoma and diabetic retinopathy. services. For information on referring patients for
March® Vision doctors may provide services, if covered, behavioral health and SUD services, call 866-673-6315.
up to the optometry scope of licensure in the state of Members should also be referred to this number for
Mississippi in accordance with the covered benefits. assistance in finding a behavioral health care provider.
Patients do not need a referral before the initial visit with 1. Inpatient behavioral health and SUD services
their selected March® Vision doctor. Patients may call for furnished in a state-operated behavioral health
an appointment or be seen immediately if you determine hospital and including residential or other 24-hour
urgent care is necessary. therapeutically planned structural services.
Call March® Vision at 844-606-2724 or visit a. Benefits for covered medical expenses are paid for
MarchVisionCare.com. medically necessary inpatient psychiatric treatment
Medical eyecare beyond the scope of primary eyecare of an enrolled child.
services, to include surgical care, is provided through b. Benefits for covered medical expenses are
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 19 Copyrighted by UnitedHealthcare 2020provided for partial hospitalization.
c. C
ertification of medical necessity by the Utilization
Management (UM) program is required for
admissions to a hospital.
d. B
enefits for covered medical expenses are
provided for the treatment of SUD, whether for
alcohol abuse, drug abuse or a combination of
alcohol and drug abuse.
e. Benefits for covered medical expenses are
provided for medically necessary inpatient
stabilization and residential SUD treatment.
f. C
ertification of medical necessity by the health
plan’s UM program is required for admissions to a
hospital or residential treatment center.
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 20 Copyrighted by UnitedHealthcare 2020Medical Management
Referral Guidelines require notification to UnitedHealthcare Community Plan
within 24 hours from admission.
You are generally responsible for initiating and
coordinating referrals of members for medically necessary Care in the Emergency Room
services beyond the scope of your practice. You are UnitedHealthcare Community Plan members who visit
expected to monitor the progress of referred members’ an emergency room should be screened to determine
care and help ensure that members are returned to their whether a medical emergency exists. Prior authorization is
care as soon as medically appropriate. We require prior not required for the medical screening.
authorization of all out-of-network referrals. The request is
UnitedHealthcare Community Plan provides coverage
generally processed like any other authorization request.
for these services without regard to the emergency care
The nurse reviews the request for medical necessity
provider’s contractual relationship with us. Emergency
and/or service. If the case does not meet criteria,
services (i.e., physician and outpatient services furnished
the nurse routes the case to the medical director for
by a qualified care provider necessary to treat an
review and determination. Out-of-network referrals are
emergency medical condition) are covered both within
generally approved for, but not limited, to the following
and outside UnitedHealthcare Community Plan’s service
circumstances:
area.
●● Continuity of care issues; and
An emergency medical condition is defined as a medical
●● Necessary services are not available within network.
condition, that manifests itself by acute symptoms of
Only in-network care providers may initiate prior sufficient severity, including severe pain that a prudent
authorizations. Authorization for out-of-network services layperson possessing an average knowledge of medicine
should be initiated by the in-network PCP or specialist. and health, could reasonably expect in the absence of
Through the provider portal, the in-network provider immediate medical attention to result in:
should appropriately indicate the care provider who is ●● Placing the health of the person afflicted with such
performing the service. condition in serious jeopardy (or, with respect to a
pregnant woman, the health of the woman or her
Out-of-network referrals are monitored on an individual
unborn child);
basis and trends related to individual care provider or
geographical locations are reported to Network Provider ●● Serious impairment to such person’s bodily functions;
Services to assess root causes or action planning. or
Additionally, in accordance with the provisions of
42 C.F.R. § 422.133-c, post-stabilization services
Emergency Care are covered and provided without the need of prior
Prior authorization is not required for emergency services. authorization if the services are medically necessary and
Emergency care should be rendered at once, with resulting from the emergency medical condition.
notification of any admission to:
866-604-3267 (Phone) Medicaid ID Requirement
888-310-6858 (Fax)
You must be enrolled in Mississippi Medicaid and have a
Admission to inpatient starts at the time the order is state provider Medicaid ID to be reimbursed for services
written by a care provider that a member’s condition has provided to a MississippiCAN member.
been determined to meet an acute inpatient level of stay.
An enhanced claim denial edit helps ensure that
Inpatient admissions resulting from emergency services no payments are made to care providers without a
Confidential and Proprietary
MississippiCAN Administrative Guide 2020 21 Copyrighted by UnitedHealthcare 2020You can also read
