MS HB1518

Requires all Division of Medicaid managed care contracts to include standardized claims processing with specific timeframes: 25 days for electronic claims payment and 35 days for paper claims, with payers having 30 days to notify providers of claim issues.

Mandates transparency in prior authorization requirements by posting all current and new requirements on the Division of Medicaid website at least 60 days before implementation, with restrictions on emergency services, medication-assisted treatment, and pre-hospital transportation.

Establishes peer-to-peer review requirements for prior authorization denials, requiring appeals to be reviewed by physicians with current Mississippi licenses in the same specialty with at least 5 years of active practice experience.

Sets credentialing timeframes requiring completion within 90 days of a complete application, with recredentialing allowed at least once every 36 months, and prohibits requiring credentialing for dental, vision, durable medical equipment, and rental equipment providers.

Defines "clean claims" as claims requiring no additional information or adjustment for payment, with specific payment deadlines and establishes that prior authorizations remain valid for one year or for the duration of chronic illness treatment.