Authority for Provider Appeals

Authority for Provider Appeals The Mississippi Division of Medicaid conducts provider hearings for the following reasons: A. The provider is dissatisfied with a Final Agency Action of the Division of Medicaid relating to: 1. Disallowances, 2. Withholding of funds resulting from overpayments, 3. Suspension of payments as a result of an audit, review or investigation, 4. Termination of a provider agreement as a result of an audit, review or investigation, 5. Suspension of provider participation as a result of an audit, review or investigation, 6. Matters relating to payment rates if not previously considered by the Division of Medicaid under Public Notice or Public Hearing Procedures, 7. Breach of provider agreement, 8. Provider disqualification, 9. Any other matter that the Division of Medicaid deems appropriate in its sole discretion at request of a party. B. Administrative hearings are also available for providers who are terminated or denied enrollment for any of the reasons set forth in 42 C.F.R. § 455.416.