2026 Healthy Mississippi Premier Advantage (HMO-POS) Plan Tiers

• Tier 1 features the lowest copays and coinsurance, representing our Preferred Network.
• Tier 2 is our Standard Network, offering the second-lowest copays and coinsurance.
• OON-POS is our out of network benefit for our HMO. For certain services, you may go out of network to see a provider. Please see your Evidence of Coverage (EOC) for more details

CMS Preventive Services and Proper Billing

Healthy Mississippi, Inc. 2025 Provider Manual

We appreciate your support and partnership in providing accessible services and the best care possible to every member. This manual outlines a framework for successfully fulfilling requirements for Healthy Mississippi’s Medicare Advantage plan. Program requirements are policies, protocols, and other administrative regulations that define Healthy Mississippi’s business requirements for network providers.

MPCN Opt-In Letter

If you participate in the Mississippi Physicians Care Network (MPCN), MPCN has agreed to help Healthy Mississippi, Inc. and affiliates to continue to build and expand their Medicare Network for their current 2025 Medicare Advantage product. Reimbursement is 100% of the Medicare fee schedule. They will also be expanding with additional plans in 2026. MPCN in no way represents nor endorses this product. To participate, YOU MUST OPT IN by filling out the information included. As with other products, by participating through your MPCN Agreement, you will not have to be credentialed, nor will you have to be contracted directly with Network.

Healthy Mississippi, Inc. 2025 Provider Kit

Thank you for your continued support and partnership in delivering accessible services and top-quality care to every member. This manual provides a framework to help you meet the requirements of Healthy Mississippi, Inc. Medicare Advantage plan. It covers the program’s policies, protocols, and administrative guidelines that outline Healthy Mississippi, Inc. expectations for network providers.

Healthy Mississippi, Inc. offers a Medicare Advantage Plan. For more information, contact the Provider Relations team at 1-833-218-8492. 

Electronic Payer ID: 99914

Claims Mailing Address:  Healthy Mississippi, P.O. Box 21069, Eagan, MN 55121

Additional Resources for Providers

Here are additional resources to help our providers continue expanding their knowledge and supporting high-quality care. These materials offer guidance on policies, protocols, and administrative requirements essential to meeting Healthy Mississippi, Inc. Medicare Advantage standards.

If you are a provider that is not contracted with us, you provided services to one of our members, and would like to appeal please use the following form. As a non-contracted provider, CMS requires that a WOL be submitted before Healthy Mississippi, Inc. can begin review of any appeal. The WOL confirms that you will not bill the enrollee for the claim, regardless of the outcome of the appeal.

To proceed with the review of your appeal, please submit the following documentation:

• •Completed Waiver of Liability (WOL) form
• •Copy of the original claim
• •Denial notice (if not already submitted)
• •Any supporting documentation justifying the appeal

Please send your completed WOL and supporting materials to:

Healthy Mississippi, Inc.

Attn: Appeals and Grievances

10 Canebrake Boulevard, Suite 110

Flowood, MS 39232

If the WOL is not received within the 65-day CMS appeal timeframe, the appeal will be dismissed in accordance with CMS regulations (Section 50.9 – Dismissals, Part C Only).

• Waiver of Liability