On July 1, the Mississippi Division of Medicaid (DOM) will implement a single Pharmacy Benefit Administrator (PBA) to streamline and enhance the processing and management of pharmacy claims for all Medicaid members, including those enrolled in MississippiCAN and CHIP.

Operated by Gainwell Technologies, the PBA will also assume all pharmacy prior authorization responsibilities for drugs submitted on pharmacy claims. DOM will continue to require the use of the Universal Preferred Drug List (PDL). This decision comes after careful consideration and evaluation of various factors aimed at enhancing efficiency and transparency in the Medicaid delivery system.

Medicaid members should notice no disruption in their care if providers are prepared for this change.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

On July 1, the Division of Medicaid (DOM) will implement a single Pharmacy Benefit Administrator (PBA) to streamline and enhance the processing and management of pharmacy claims for all Medicaid members, including those enrolled in MississippiCAN. Operated by Gainwell Technologies, the PBA will also assume all pharmacy prior authorization responsibilities for drugs submitted on pharmacy claims. DOM will continue to require the use of the Universal Preferred Drug List (PDL). This decision comes after careful consideration and evaluation of various factors aimed at enhancing efficiency and transparency in the Medicaid delivery system. Medicaid members should notice no disruption in their care if providers are prepared for this change.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Save the date for the Mississippi Pharmacists Association’s Back to the Basics Consultant Seminar on April 18, 2024. Class offerings include “Consulting 101/Pharmacology,” “Appendix PP,” “Mental Health,” “Antibiotic Stewardship” and more. Attendees may receive eight hours of continuing pharmacy education (CPE).

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Telligen to replace Alliant Health Solutions and Kepro as Medicaid UM/QIO Vendors: 

Early in 2024, the Division of Medicaid (DOM) will transition to a new Utilization Management/Quality Improvement Organization (UM/QIO) vendor, Telligen. 

Telligen will replace the following vendors:  

• Alliant Health Solutions, who was responsible for medical authorization requests for fee-for-service (FFS) Medicaid members, and  

• Kepro (formerly eQHealth Solutions), who was responsible for advanced imaging authorization requests for FFS Medicaid members. 

To ensure a smooth transition, Telligen web portal registration instructions and educational materials will be shared in the upcoming weeks through a variety of communication avenues to ensure no provider lacks access to necessary resources and assistance. Updates will also be publicized on the DOM website and Late Breaking News. 

Please note: Prior authorizations for members enrolled in MississippiCAN and CHIP will continue to be handled by the respective coordinated care organization. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

With the federal government ending the continuous Medicaid coverage requirement on March 31, the Mississippi Division of Medicaid (DOM) is notifying Medicaid members that eligibility renewals will begin on April 1. DOM urges all Medicaid members to make sure their contact information is correct by clicking here.  

To prepare for the return to annual renewals, DOM is sending notices to recipients alerting them to the change in federal requirements and to look for renewal forms in the mail in the months ahead.  

To learn more, please click here. 

 Ways you can help:  

• Help DOM share valuable information and resources to ensure eligible members keep their health coverage with this online Toolkit.  

• Sign up to be a Coverage Champion and partner with DOM as we outreach resources and strategies.  
• Sign up to receive Late Breaking News Alerts directly to your email every time DOM issues a Late Breaking News update! Just email a contact name, place of business and a contact number (optional) to LateBreakingNews@medicaid.ms.gov.  
• Visit Late Breaking News online at: https://medicaid.ms.gov/late-breaking-news/.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

New Medicaid Paper Claims Billing Manual available online. In preparation for the Mississippi Division of Medicaid’s (DOM) transition to a new Fiscal Agent effective Oct. 3, a newly developed Paper Claims Billing Manual, produced by Gainwell Technologies, is available on the is available on the DOM website. 

The Paper Claims Billing Manual is designed to offer guidance and assistance to providers submitting claims for reimbursement to DOM, including detailed information specific to the submission of paper claims. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Conduent pharmacy point-of-sale claims system to shut down on Thursday, Sept. 29, 2022, as part of Fiscal Agent transition – Mississippi Division of Medicaid. Contact Medicaid for any questions you may have. 

Also in Mississippi, the Mississippi Public Health Institute would like your input regarding planned opioid-related training for healthcare providers. This survey should take approximately 3 minutes to complete. Responses will be disconnected from any identifying information provided prior to the analysis of survey results. This survey was developed for needs assessment only and does not meet the definition of human research.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Effective July 1, 2022, the Mississippi Division of Medicaid (DOM) reestablished payment methods for the ingredient costs of prescription drugs that existed prior to the July 1, 2021 rate freeze. This change removed the freeze for dates of service on or after July 1, 2022. On 8/22/2022, Conduent will begin adjusting claims with dates of service of 7/1/2021 through 6/30/2022 to reflect the ingredient cost of the drug in effect on the claim’s date of service. 

Also in Mississippi, the Pharmacy Association will hold its 2022 Consultant Seminar on October 13, 2022, 8:00 a.m. – 5:00 p.m. Please visit their website for more information or Contact Mindy Phillips at mindy@mspharm.org if you have any questions or need assistance. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Mississippi Division of Medicaid (DOM) is in the process of implementing a new Medicaid Management Information System (MMIS) – which will include a new Provider Portal – known as MESA: Medicaid Enterprise System Assistance. The new system, going live at the beginning of October, is being developed by Gainwell Technologies.

Before switching over to the new system, every Medicaid-enrolled provider, clearing house or billing services vendor that currently submits electronic data transactions (for example, filing claims) to DOM must undergo Electronic Data Interchange (EDI) registration and testing with Gainwell Technologies. This process for ensuring the secure transmission of electronic information is required of all states when implementing a new system.

Medicaid providers are asked to identify their designated staff member, someone who is already involved in the submission of claims or other electronic transactions within the current provider portal, and direct them to this page on DOM’s website:

This also applies to any trading partner or billing services vendor that submits claims on behalf of a provider.

The website provides step-by-step instructions and supporting materials on how to register as a trading partner through an online portal and test electronic transactions. Providers are asked to begin this process as soon as time allows.

If providers have any questions about which representatives should be designated to follow these steps, please contact Gainwell’s Help Desk at MS_EDI_Helpdesk@dxc.com.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.