Outpatient Prior Authorization Form - Magnolia Health Plan 2025

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  1. Click ‘Get Form’ to open the Outpatient Prior Authorization Form in our platform.
  2. Begin by filling in the MEMBER INFORMATION section. Enter the Member ID/Medicaid ID and Date of Birth, ensuring all required fields marked with an asterisk (*) are completed.
  3. In the REQUESTING PROVIDER INFORMATION section, provide your NPI, TIN, contact name, and phone number. This information is crucial for processing your request.
  4. Next, complete the SERVICING PROVIDER / FACILITY INFORMATION. If applicable, check 'Same as Requesting Provider' to auto-fill details or enter them manually.
  5. Fill out the AUTHORIZATION REQUEST section with relevant procedure codes and diagnosis codes. Ensure you include all necessary ICD-9/ICD-10 codes and any additional procedure codes if needed.
  6. Finally, review all entries for accuracy before submitting. Remember that incomplete forms may be rejected.

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Ambetter from Magnolia Health is offered statewide, in all 82 Mississippi counties.
Centene Corporation, a Fortune 500 company in the managed care industry, is the parent company of Magnolia Health.
Magnolia Health is a coordinated care organization thats contracted with Mississippis Division of Medicaid. Magnolia Health has achieved accreditation status from the National Committee for Quality Assurance. Like many insurance companies, Ambetter From Magnolia Healths product offerings include HMO plans.

People also ask

Alliant Health Solutions is the current vendor responsible for prior authorization requests for fee-for-service (FFS) Medicaid beneficiaries. Please click here to direct you to the Alliant official website, or call Alliant directly at 1-888-224-3067.
Get complete healthcare coverage in Mississippi with Ambetter from Magnolia Health. Check out the map below to see where we offer our Marketplace plans. Find coverage in your area. Call us today at 1-877-687-1187 (Relay 711).
Magnolia Health, a subsidiary of Centene Corporation, was awarded a contract to serve Medicaid beneficiaries in Mississippi. Magnolia has a commitment to deliver results for the people we serve.
Please contact Member Services by phone at 1-877-687-1187 (Relay 711) to speak directly to a customer services representative or use the Secure Member Portal. We are happy to assist with any general information via email.
Ambetter HMO and Ambetter PPO plans are offered by Health Net of California, Inc. In our continued commitment to support you as you serve your clients, weve provided answers to your most important questions. This page will be updated periodically so please bookmark it, as well as our member FAQ page.

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