MS SB2175

Establishes standardized credentialing process for health care providers (physicians, PAs, NPs, APRNs) seeking to provide services to Medicaid beneficiaries through managed care organizations, with completion required within 90 days of receiving complete application or 30 days if provider already has Medicaid number.

Requires managed care organizations to notify applicants within 30 days of application defects and within 60 days if verification documents have not been received; mandates use of Mississippi Standardized Credentialing Application Form.

Permits interim credentialing allowing group-based health care providers to submit claims and receive reimbursement at negotiated rates while credentialing is pending, if provider has active hospital privileges and no denial has been issued within 30 days.

Requires standardized claim payment information including patient name, Medicaid claim number, service dates, CPT codes, payment amounts, and patient cost-sharing, with specific denial reason codes matching state fee-for-service Medicaid program codes.

Effective date July 1, 2016.