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Become a Provider

Thank you for your interest in participating with Magnolia. Non-contracted providers may request a contract by completing the form at the link provided below. Please allow up to 30 days for evaluation and response to your request.

Contract Request Form 

Providers requesting MississippiCAN must be credentialed through Gainwell and obtain an active MSCAN Medicaid ID before requesting a contract.

To complete this process, please visit the MESA Portal for Providers.

 

Providers requesting Ambetter and/or WellCare will be required to provide the following documents prior to receiving a contract:

  • W-9
  • Complete Credentialing Application
  • Copy of Certificate of liability insurance for facilities and providers (Must not expire within 60 days) Disclosure of Ownership and Control Interest Statement
  • Copy of DEA Certificate Collaborating Physician Form
  • Copy of Clinical Laboratory Improvement Amendments (CLIA) Accreditation/Site Visit letter
  • State License(s) Rate Letter for RHCs
    *Additional documents may be requested depending on provider type

Non-contracted Vision Providers, please contact:

Non-contracted Dental Providers, please contact:

Non-Contracted Pharmacy Providers, please contact:

If you are a contracted Provider requesting to enroll a new Practitioner and/or a new location or group NPI under your existing contract, complete the following documents and email to MagnoliaCredentialing@centene.com for MSCAN and Ambetter and MSProviderUpdates@centene.com for WellCare:

*If you select multiple lines of business, you will be required to complete Magnolia’s Credentialing Application Magnolia Credentialing Application Packet

 

If you are a contracted Provider requesting to make a demographic change to a location address, phone number, email address, office hours, etc. for MSCAN and Ambetter, please visit our Demographic Update Tool.

WellCare demographic updates should be emailed to MsProviderUpdates@centene.com