Secure Portal FAQs

Can I check member eligibility online?: Yes, you can look up your patients’ eligibility by entering the patient name and date of birth, Medicaid I.D. or other search criteria to get instant eligibility search results.
You can find out more, including eligibility history, member details and PMP details, by clicking on the member’s name.
Is it possible to search for a list of patients by provider?: You can now conduct a patient list search under the Eligibility tab. This expanded function allows you to find and sort patient details by name, I.D., SSI, gender, date of birth, age, address and/or provider name.
Is it possible to confirm the status of a submitted claim online?: You may confirm the status of your submitted claims through our new online claims search feature. Just enter your search criteria to find out if a claim has been paid, is set to pay or is still pending.
You can also see a full description of your claims status, including what the payment amount was, the date it was paid and the claims check number.
Does the portal offer secure messaging so that I may get my questions answered online?: Yes, providers and their representatives may communicate directly with us via secured e-mail. It’s fast and you can send messages seven days a week, 24 hours a day.
You can ask us questions about your claims status, including adjustments and lost checks.
You can also email us via our contact-us page.
Can I search for other providers, including specialists, online?: Yes, you can search for providers and specialists by using our electronic Provider Directory. Look for doctors or medical facilities by entering your required criteria.
What if I get an error message or can’t find the results I’m looking for?: The portal will redirect you to the page where you started so that you can try again using different criteria. If you continue to have trouble, e-mail us directly using our secure e-mail messaging.
When are authorizations required?: Authorizations are required for certain services/procedures that are frequently over- or under-utilized services/procedures, or services indicating a need for care management. You must request an authorization before rendering services.
What is the difference between referrals and authorizations?: A referral is requested from a provider to a provider and an authorization is a request from a provider to MHS for certain services to be rendered to a patient.
Who can obtain authorizations?: PMPs must obtain authorizations for certain services. Specialists may obtain authorizations once the PMP has given a referral to the Specialist.
How are authorizations obtained?: There is absolutely no paperwork involved!
PMPs or Specialists must initiate authorization of non-emergency services at least five working days prior to the requested date of service. The Primary Medical Provider simply calls Medical Management at (877) 647-4848, where a Referral Specialist will enter demographic information and then transfer the call to a Nurse for completion of medical necessity screening.
If a provider is unable to request prior authorization at least five working days in advance due to the nature of the condition, he or she must initiate an authorization request ASAP.
Will the online eligibility search produce the most current results?: We update our information twice a month.