HSM ensures that the care provided to Medicaid beneficiaries meets the professionally recognized standard of care through:

• Applying generic quality screens to each utilization review

• Performing a complete quality review on a random 5% Quality Sample for each care setting

• Identifying patterns of quality problems in the care of Medicaid beneficiaries by working collaboratively with providers to remedy identified quality patterns through education and interventions through a Quality Intervention Committee (QIC)

• Overseeing internal quality improvement activities through an Internal Quality Control Committee (IQC)

Quality Rereview Request and Intervention Committee Correspondence Fax Line:      1-888-204-0506

Back to Top

HSM provides any beneficiary, facility, or physician who receives a Utilization Review Denial Notice the opportunity to request and receive a reconsideration of a determination.

HSM advises any involved party (beneficiaries, representatives, providers, and physicians) in writing, of all initial denial determinations. All parties are notified of the right to request reconsideration and the timeframes for submitting a request. Any party who receives a denial notice and disagrees with the determination may request a reconsideration of the determination.

For additional information on how to initiate the reconsideration process, refer to your HSM Provider Manual, Utilization Review Activities section for the Reconsideration Policy and Procedure.

Reconsideration Phone Line:  601-360-4875

Reconsideration Fax Line: 1-877-272-8706

The HSM Education/Communication Department staff is available to explain and educate Mississippi Medicaid Providers on the types of services HSM provides. HSM offers various educational services to inform providers with information regarding appropriate utilization of health care, clinical criteria, and current patterns and trends identified through:

• On-site and off-site individual provider workshops

• Annual statewide workshops

• Publications

• Help Line and hot line communications

For information on types of HSM educational services or offerings contact our Education Department at education@hsom.org.

Education Phone Line:  601-360-4961

Education Fax Line:  601-360-4967