Provider Services Communication Update

Date: 11/07/16

Effective November 7, 2016, Magnolia Health will be expanding its Provider Services and Call Center to better meet provider needs.  Due to the growth of members and our provider network, providers will not be limited to a single Provider Relations Specialist, but will be able to use several communication tools.  Contact via phone, e-mail, or the messaging function on our secure web portal rather than reaching out directly to a Provider Relations Specialist, will provide faster access for inquiries to Magnolia Health. Provider Services is our first line of communication and provides services such as, but not limited to:

• Assisting Providers with questions concerning Member eligibility status
• Assisting Providers with Prior Authorization and referral procedures
• Assisting Providers with claims payment procedures and handling Provider dispute and issues
• Providing to PCPs a monthly list of Members who are under their care, including identification of new  and deleted Members; An explanation guide detailing use of the list must also be provided to the PCP
• Referring Providers to the Fraud and Abuse Hotline

PHONE/EMAIL:

Below you will find the contact information for MSCAN, CHIP, and Ambetter.

SECURE MESSAGING:

You are also able to contact Provider Services via the secure web portal by using the “secure messaging” function.

We are excited about this change! Our new processes will allow quicker response times to provider inquiries. If Provider Services is unable to assist you with your inquiry, they will route your inquiry to the appropriate department within the health plan. Provider Services will provide you with a reference number that pertains to the inquiry. Please keep track of the reference number provided so our call center can easily track your inquiry when you call for an updated status.

Prior to contacting Provider Services, you may find the answer that you are looking for through one of the functions we offer below:

Magnolia’s IVR (interactive voice response) System

What’s great about the IVR system? It’s free and easy to use.  The IVR provides you with greater access to information. Through the IVR you can:

• Check member eligibility
• Check claims status
• Access 24 hours a day, seven (7) days a week, 365 days a year

Magnolia Website -https://www.magnoliahealthplan.com/    

Utilizing Magnolia’s website can significantly reduce the number of telephone calls providers need to make to the health plan which enables Magnolia staff to effectively and efficiently perform daily tasks.

Once you enter our website, you will be able to select the product that you have questions about. Providers can find the following information on the website:

• Member benefits
• Magnolia news
• Clinical guidelines
• Wellness information
• Provider Manual and Forms
• Provider newsletters
• Provider Directory
• Access to link to the State’s PDL

Magnolia’s Secure Portal -https://www.magnoliahealthplan.com/providers/login.html            

Magnolia web portal services allows providers to check member eligibility and benefits, submit and check status of claims, request authorizations, and send/receive messages to communicate with Magnolia staff. Magnolia’s providers and their office staff have the opportunity to register for our secure provider website in just four (4) easy steps. Here, we offer tools which make obtaining and sharing information easy! It’s simple and secure!

Through the secure site, you can:

• View the PCP panel (patient list)
• Update Provider Demographics
• View and submit claims and adjustments
• View and submit authorizations
• View payment history/remittance advice
• View member gaps in care
• Check member eligibility
• Contact us securely and confidentially