{"data":{"id":"us-ms/miss.-code-ann.-83-41-409","jurisdiction":"us-ms","citation":"Miss. Code Ann. § 83-41-409","heading":"Conditions for certification or recertification.","body":"In order to be certified and recertified under this article, a managed care plan shall:\n(a) Provide enrollees or other applicants with written information on the terms and conditions of coverage in easily understandable language including, but not limited to, information on the following:\n(i) Coverage provisions, benefits, limitations, exclusions and restrictions on the use of any providers of care;\n(ii) Summary of utilization review and quality assurance policies; and\n(iii) Enrollee financial responsibility for copayments, deductibles and payments for out-of-plan services or supplies;\n(b) Demonstrate that its provider network has providers of sufficient number throughout the service area to assure reasonable access to care with minimum inconvenience by plan enrollees;\n(c) File a summary of the plan credentialing criteria and process and policies with the State Department of Insurance to be available upon request;\n(d) Provide a participating provider with a copy of his/her individual profile if economic or practice profiles, or both, are used in the credentialing process upon request;\n(e) When any provider application for participation is denied or contract is terminated, the reasons for denial or termination shall be reviewed by the managed care plan upon the request of the provider; and\n(f) Establish procedures to ensure that all applicable state and federal laws designed to protect the confidentiality of medical records are followed.","path":["Title 83. Insurance","Chapter 41. Hospital and Medical Service Associations and Contracts","Article 9. Patient Protection Act of 1995."],"source_url":"https://archive.org/download/gov.ms.code.ann.2018/release78.2020.07.08/gov.ms.code.title.83.odt","current_through":"2020-07-08","vintage":"Mississippi Code Release 78 (2020-07), retrieved 2026-09-17","retrieved_at":"2026-10-27T05:54:33Z","sha256":"973cfa7caa7d9001de0f1540edca51867acb499287df4b9efa43184d6c914a75","source_id":"us-ms","stale":false,"prev":"us-ms/miss.-code-ann.-83-41-407","next":"us-ms/miss.-code-ann.-83-41-411","notices":[{"id":"open-us-law","title":"Open US Law compilation","text":"Compilation CC BY 4.0, Open US Law (Vaquill AI). GroundRules uses only the releases published under CC BY 4.0: from v2026.09 the compilation is licensed CC BY-NC 4.0, and GroundRules does not use those releases. Each affected row names its release in its vintage label. GroundRules parsed and filtered the compilation to retain enacted text.","url":"https://huggingface.co/datasets/vaquill/open-us-law","license_url":"https://creativecommons.org/licenses/by/4.0/"},{"id":"pro-ms","title":"Mississippi Release 78 supplement","text":"Mississippi electronic product files were republished by Public.Resource.Org under a public-domain dedication. GroundRules uses enacted text from Release 78 only as a labeled supplement to the newer Open US Law rows.","url":"https://archive.org/details/gov.ms.code.ann.2018"}]},"notice":"GroundRules: Original legal text. Not legal advice."}