[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288926-105":53,"doc-detail-288926-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","medicaid-pharmacy-prior-authorization-additional-instructions-72-hour-emergency-supply","Medicaid Pharmacy Prior Authorization - Additional Instructions - 72 Hour Emergency Supply","","Additional instructions for completing Mississippi Medicaid pharmacy prior authorization (PA) requests for Medicaid Fee-for-Service and MSCAN beneficiaries. Guidance covers required elements of the standardized one page PA packet and supporting criteria documentation, who may submit PA requests, and when a NCPDP 75 code triggers PA. The document explains two submission options (online via MESA portal or fax), expected determination timing, 72-hour emergency supply rules, and what happens after approval or denial. It also provides the appeal request purpose, policy, deadlines, and where to forward written requests, including emergency supply handling.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/medicaid-pharmacy-prior-authorization-additional-instructions-72-hour-emergency-supply/288926/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/medicaid-pharmacy-prior-authorization-additional-instructions-72-hour-emergency-supply/288926.png","ImageObject",442,249,{"name":88,"@type":89},"Felix Montgomery","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-12","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",10,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information is required to be completed for a Medicaid pharmacy prior authorization request?","Question",{"text":109,"@type":110},"All information requested within the appropriate PA packet must be completed for consideration and approval, including the Standardized One Page Pharmacy Prior Authorization Form and the Criteria/Additional Documentation Form.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How can a pharmacy prior authorization request be submitted for a Medicaid Fee-for-Service beneficiary?",{"text":114,"@type":110},"Two options are available: online submission is recommended via the MESA provider portal, or fax submission is available using 1-866-644-6147.",{"name":116,"@type":107,"acceptedAnswer":117},"What are the rules for requesting a 72-hour emergency supply?",{"text":118,"@type":110},"If a PA is not available, a 72-hour emergency supply may be dispensed. Pharmacists must use professional judgment about immediate need each time the option is used, and the emergency procedure must not be used for routine and continuous overrides.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},288926,1790251977,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},549768064778,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Additional Instructions for Completing a Medicaid Pharmacy Prior Authorization  \nNotice: The Division of Medicaid (DOM) encourages Medicaid providers to use equally efficacious and cost saving preferred agents whenever possible; most preferred drugs do not require PA. There are multiple preferred alternatives for non-preferred drugs. Before submitting a PA request, remember to check for options not requiring PA at the current PDL which may be referenced at  \nCompleting a Prior Authorization  \n• Please note the instructions on this page are for beneficiaries enrolled in both Medicaid Fee-forService and MSCAN.  \n• MS Division of Medicaid requires that all information requested within the appropriate packet be completed for consideration and approval. The “Standardized One Page Pharmacy Prior Authorization Form” as well as the “Criteria/Additional Documentation Form” are required as part of the completed PA packet.  \n• The requested information is required by the respective plan’s Pharmacy PA Unit in order to quickly assess the prior authorization request. Requests submitted with missing information will not be considered until that information is provided.  \n• Only the prescribing provider or one of their authorized staff representatives may request a pharmacy prior authorization from the Pharmacy PA unit.  \n• When a claim returns the NCPDP request code 75 (\"Prior Authorization Required”), a prior authorization is required.  \n• Please note: PA requests submitted by agents of drug manufacturers should not be submitted, pursuant to policy, and shall be denied.  \nThere are two options to request a prior authorization for a FEE-for-SERVICE Medicaid beneficiary:  \nA.) Online: RECOMMENDED-The quickest, most efficient way to enter and process a Prior Authorization.  \nIf you are a MS MEDICAID PRESCRIBER, please submit your PA requests via the MESA (Medicaid Enterprise System Assistance) provider portal for the most efficient processing.  \n[https://portal.MS-Medicaid-MESA.com/MS/Provider](https://portal.MS-Medicaid-MESA.com/MS/Provider)  \n[B](B).) Facsimile: 1-866-644-6147  \nPlease call Gainwell Technologies for additional assistance – 1-833-660-2402  \nPage 1  \n72 Hour Emergency Supply  \nPrior authorizations are reviewed, and a determination notice provided within twenty-four (24) hours from receipt of request. If a PA is not available, a seventy-two (72) hour emergency supply may be dispensed. Pharmacists should use their professional judgment regarding whether there is an immediate need everytime the seventy-two (72) hour option is used. The seventy-two (72) hour emergency procedure must not be used for routine and continuous overrides. [https://medicaid.ms.gov/wp](https://medicaid.ms.gov/wp)  \ncontent/uploads/2015/06/72HR ER Prescription.pdf  \nPrior Authorization Determination  \nIf the Pharmacy PA unit approves the prior authorization, the beneficiary can return to their pharmacy to obtain the prescription. The drug claim will pay and no further action will be required.  \nIf the Pharmacy PA unit denies the request, the prescriber’s office and the beneficiary will be notified. The prescriber has the option of prescribing a different treatment course that does not require prior authorization or by contacting the respective plan’s Pharmacy PA Unit and requesting a first reconsideration.  \n• Medicaid Fee-for-Service/Gainwell Technologies  \n• Magnolia Health/Envolve  \n• UnitedHealthcare/OptumRx  \n• Molina/CVS Caremark  \n1-833-660-2402  \n1-866-399-0928  \n1-800-310-6826  \n1-844-826-4335  \nREMINDER: Before submitting a PA request, check for options not requiring PA on the current Universal PDL found at [http://www.medicaid.ms.gov/providers/pharmacy/preferred-drug-list/](http://www.medicaid.ms.gov/providers/pharmacy/preferred-drug-list/ Medicaid providers are)[ Medicaid providers are](http://www.medicaid.ms.gov/providers/pharmacy/preferred-drug-list/ Medicaid providers are)[ ](http://www.medicaid.ms.gov/providers/pharmacy/preferred-drug-list/ ","cbCaieQs0aiQiABB","https://ap.wps.com/l/cbCaieQs0aiQiABB","pdf",255408,"English","# Completing a Prior Authorization\n## Required PA Packet Information\n## Submission Options (Online and Fax)\n## 72 Hour Emergency Supply\n# Prior Authorization Determination\n## If Approved\n## If Denied\n# Request for an Appeal\n## Purpose and Policy\n## Forwarding Written Requests","[{\"question\":\"What information is required to be completed for a Medicaid pharmacy prior authorization request?\",\"answer\":\"All information requested within the appropriate PA packet must be completed for consideration and approval, including the Standardized One Page Pharmacy Prior Authorization Form and the Criteria/Additional Documentation Form.\"},{\"question\":\"How can a pharmacy prior authorization request be submitted for a Medicaid Fee-for-Service beneficiary?\",\"answer\":\"Two options are available: online submission is recommended via the MESA provider portal, or fax submission is available using 1-866-644-6147.\"},{\"question\":\"What are the rules for requesting a 72-hour emergency supply?\",\"answer\":\"If a PA is not available, a 72-hour emergency supply may be dispensed. Pharmacists must use professional judgment about immediate need each time the option is used, and the emergency procedure must not be used for routine and continuous overrides.\"}]","Medicaid Pharmacy Prior Authorization - Additional Instructions - 72 Hour Emergency Supply | PDF",1789634232]