MS HB368

Establishes standardized credentialing processes for health care providers (physicians, PAs, NPs, and APRNs) seeking approval from managed care organizations to serve Medicaid beneficiaries, with completion within 90 days of receiving all required documentation or 30 days if provider already has a Medicaid number.

Requires managed care organizations to notify applicants within 30 days of incomplete applications and within 60 days if needed verifications have not been received.

Mandates use of the Mississippi Standardized Credentialing Application Form for all provider applications to ensure uniform submission across managed care organizations.

Allows interim credentialing payments at contracted group rates for new providers joining existing provider groups if they are already credentialed elsewhere or have submitted complete applications with proof of active hospital privileges.

Requires managed care organizations to provide itemized claim payment information including patient name, Medicaid claim number, service dates, CPT codes, allowed amounts, patient responsibility, and payment amounts; denied claims must include specific denial reason codes.