State · MS
Medical billing services in Mississippi
Short answer
Medical billing services in Mississippi run on two tracks: fee-for-service claims go to the Division of Medicaid through the MESA provider portal, and most members sit in MississippiCAN, where Magnolia Health Plan, Molina Healthcare and TrueCare pay their own claims. CMS counted 74.2 percent of Mississippi Medicaid enrollees in full-benefit managed care in 2024.
The Division's rules allow 365 days from the date of service to file, every EVV claim has gone through HHAeXchange since December 1, 2025, and a commercial insurer owes payment on a clean electronic claim within 25 days. A Remitwright dedicated biller works each payer's rules, serving Mississippi practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in Mississippi: what's different
The rules below change how a claim is filed and paid in Mississippi. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In Mississippi | Source |
|---|---|---|
| Medicaid program | Mississippi MedicaidMississippi Division of Medicaid (DOM) | 1 |
| Fee-for-service portal | MESA Provider Portal | 1 |
| How Medicaid is delivered | Mostly managed care | 4 |
| Managed care plans | 3 plansMagnolia Health Plan, Molina Healthcare, TrueCare | 1 |
| Medicaid timely filing (fee-for-service) | 365 calendar days from the date of service | 3 |
| Prompt-pay law | Miss. Code Ann. § 83-9-5(1)(h) | 8 |
| NEMT | Broker model | 7 |
Mississippi Medicaid
Mississippi Medicaid is run by the Mississippi Division of Medicaid (DOM). Fee-for-service claims and provider enrollment go through the MESA Provider Portal1, at portal.ms-medicaid-mesa.com. Mostly managed care: CMS counted 478,746 of Mississippi's 645,050 Medicaid enrollees, 74.2 percent, in full-benefit managed care in 20244. The figure comes from CMS's annual Medicaid Managed Care Enrollment Report, which counts members by the type of plan they are enrolled in.
Fee-for-service filing limit: 365 calendar days from the date of service for a claim to be submitted to the Division of Medicaid, including claims from newly enrolled providers3. When a coordinated care organization recoups a paid claim because the member moved to fee-for-service, the claim goes to the Division within the same 365 days or, if the recoupment comes after that period, within 90 calendar days of the recoupment. A claim related to a timely Medicare claim is processed within 180 calendar days after the Medicare disposition, and a provider that misses the limit cannot bill the beneficiary. Managed care plans set their own limits in their provider manuals, so the deadline on a Mississippi Medicaid claim depends on which plan holds the member on the date of service.
Managed care plans1
- Magnolia Health Plan
- Molina Healthcare
- TrueCare
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Mississippi Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in Mississippi9: Ambetter Health, UnitedHealthcare, Oscar Health Plan. Filing windows, corrected-claim processes and appeal levels differ from one to the next, and each payer sets them out in its own provider manual; the timely filing limits table gathers verified payer deadlines with their sources.
Clean-claim payment window under Miss. Code Ann. § 83-9-5(1)(h): 25 days after the insurer receives a clean electronic claim and 35 days for a paper claim, with interest of 3 percent a month on benefits still unpaid after that8. These are the terms of section 83-9-5 as House Bill 1079 amended it, approved by the Governor on April 17, 2024 and in force from passage. A clean claim needs no further information, adjustment or alteration to be processed and paid, and the definition leaves out duplicates filed within 30 days of the original, fraudulent claims, claims that need preexisting condition, coordination of benefits or subrogation information, and claims a provider submits more than 30 days after the date the service was completed. A claim resubmitted with the documents the insurer asked for must be paid within 20 days of receipt, and the interest rule does not apply to Medicare Advantage claims. That window sets the pace of A/R follow-up. Once a clean claim passes it, the claim is escalated to the payer with the statute cited, and interest is requested where the law provides for it.
NEMT and home care in Mississippi
Non-emergency medical transportation. Broker model: Modivcare is Mississippi's coordinator for nonemergency transportation and arranges rides for eligible fee-for-service Medicaid beneficiaries statewide, booked at least three business days in advance unless the trip is urgent7. Members schedule on Modivcare's scheduling line. A separate Where's My Ride line handles pickups more than 15 minutes late, and members and transportation providers each have their own complaint line. The NEMT billing in Mississippi page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. HHAeXchange, under the Division of Medicaid's partnership with FEI Systems: since December 1, 2025 the Administrative Code has required every EVV claim to go through HHAeXchange, and from January 1, 2026 claims edit 712 suspends a claim for an EVV-mandated service that is sent straight to MESA10. Agencies either use the free HHAeXchange EVV Portal, live for waiver providers since August 1, 2023 and for state plan personal care, private duty nursing and home health providers since December 11, 2023, or send visits from their own EVV system by EDI and reconcile claims in the HHAeXchange portal. Under the EVV contracts HHAeXchange lists with Magnolia, Molina and UnitedHealthcare, visits are recorded in HHAeXchange and billed to the plan directly; TrueCare members' EVV and billing rules are confirmed with TrueCare. See home care billing in Mississippi for waiver programs, EVV exceptions and authorizations.
Rules that change how Mississippi claims are billed
MississippiCAN is a statewide 1932(a) program with a 30-day choice period5
CMS's 2024 state tables describe MississippiCAN as a statewide full-benefit MCO program running since January 1, 2011 under 1932(a) authority, with Gainwell Technologies as the enrollment broker and a 30-day enrollment choice period. Enrollment is mandatory for low-income adults, aged, blind or disabled members, children and limited-benefit groups, plans must hold NCQA accreditation, and Constellation Quality Health is the external quality review organization. The 2024 participating plans were Magnolia Health Plan, UnitedHealthcare Community Plan and Molina Healthcare, while the Division's current list names Magnolia, Molina and TrueCare.
A coordinated care organization recoupment reopens the fee-for-service window for 90 days3
Rule 1.6 of Part 200 sets one deadline for every provider: 365 calendar days from the date of service, and a newly enrolled provider can bill only for services on or after its enrollment date. The exception that matters in a mixed payer mix is the recoupment. When a coordinated care organization pays a claim and later takes the money back because the member was moved to fee-for-service, the practice refiles with the Division within 365 days of the service or, if the recoupment lands after that, within 90 calendar days of it. The rule cites 42 CFR 447.45 as its federal source.
EVV claims go through HHAeXchange, and edit 712 suspends the ones sent to MESA10
The Division updated Part 200 of its Administrative Code to require every EVV claim to be submitted through HHAeXchange from December 1, 2025, and from January 1, 2026 new claims edit 712 suspends any claim for an EVV-mandated service submitted directly in MESA. An agency on its own EVV system sends visit data by EDI and still reconciles and submits its claims in the HHAeXchange provider portal. Fixed object devices are issued only to the first-phase waiver providers, not to home health or state plan personal care and private duty nursing agencies.
Clean commercial claims are due in 25 days, and late ones carry 3 percent a month8
Section 83-9-5(1)(h), as House Bill 1079 amended it in 2024, requires an insurer to pay benefits within 25 days after it receives a clean electronic claim and within 35 days for a paper claim, or by then to pay any clean portion and tell the provider what documentation the rest needs. A claim not denied for valid and proper reasons by the deadline earns interest at 3 percent a month until it is settled, except on Medicare Advantage claims, and a provider contract may set its own payment terms only if they are at least as stringent, with the statutory interest applying when the contract is silent on it. The catch for a billing office is the clean claim definition: a claim the provider submits more than 30 days after the date the service was completed is not a clean claim, so the statutory clock only protects claims sent promptly.
The Division publishes the error guides and companion guides a biller works from2
The Division of Medicaid's resources page carries the current fee schedules, the Gainwell EDI companion guides for the 837P, 837I, 837D, 835, 270/271, 276/277 and 278 transactions, the Timely Filing Request form, six-month revalidation, recredentialing and license due lists, and quick reference guides for MESA claim errors. Error 2017 means the member is enrolled in a managed care CCO, error 2503 means the member is in Medicare Part C on the date of service, and error 5000 flags a duplicate of another claim.
CMS found Mississippi's home health EVV non-compliant at the start of 202412
CMS wrote to the Division on December 29, 2023 that Mississippi did not meet the Cures Act EVV requirement for home health care under the section 1905(a)(7) benefit and its 1915(c) waivers, that the state was finishing EVV upgrades in early 2024 and expected compliance by March 30, 2024, and that FMAP reductions would apply from the first quarter of 2024, rising from 0.25 percentage points in 2024 to 1 percentage point in 2027 and later years for each non-compliant quarter.
Services for Mississippi practices
Remitwright serves Mississippi practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from Mississippi practices
Which MississippiCAN plans do we contract with in Mississippi?
What is the Mississippi Medicaid timely filing limit?
Who arranges Medicaid transportation in Mississippi?
Where do Mississippi Medicaid fee-for-service claims go?
How quickly must a Mississippi insurer pay a clean claim?
Does Mississippi Medicaid require EVV for home care visits?
Which commercial payers did you list for Mississippi, and why those?
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