MedicaidAdministrativeMedium impact
Simplified Claims Adjustment Reporting on RA
Mississippi Medicaid (DOM)·MS · Ophthalmology, Optometry, Physical Therapy +2 more·Claims & Billing
Effective date
Jul 1, 2026
We identified it
Jun 21, 2026
Summary
Mississippi Medicaid issued multiple policy updates including drug formulary changes, hospital payment methodology updates, vision services fee corrections, and new provider services. Key changes include Farxiga moving to non-preferred status, APR-DRG payment parameters updating, and vision service claims being reprocessed for corrected fees.
Action Required
By July 1, 2026: Update billing systems to reflect Farxiga as non-preferred requiring prior authorization for brand name, with generic dapagliflozin as preferred. Monitor remittance advices for vision service claim reprocessing for codes 92002-92371 with corrected SFY 21 fees. For therapy prior authorizations, ensure modifiers (GN, GO, GP) on PA requests exactly match claim modifiers to prevent denials. Claims originally paid by CCOs but recouped due to enrollment transitions must be resubmitted to FFS within 365 days of service date or 90 days of recoupment.