Navigating the NMHS Health Plan

North Mississippi Health Services has developed comprehensive provider resources to help Health Link and Connected Care Partners providers successfully navigate the NMHS Health Plan. 

The materials on this site are designed to help physicians and their office teams provide better patient care while reducing administrative burdens associated with health plan management. 

Key benefits include:

• Faster Access to Information: Physicians and office staff learn how to use the UMR Provider Portal to verify eligibility, manage claims, access resources and track authorizations efficiently
• Improved Claims and Reimbursement Processes: The video below explains claim submission requirements, common denial scenarios and best practices that can help reduce payment delays and administrative rework
• Clear Understanding of Prior Authorizations: Providers receive guidance on when prior authorizations are required, how to submit them correctly and expected turnaround times, helping avoid unnecessary delays in patient care
• Improved Patient Access to Care: Physicians learn how the NMHS Health Plan network operates, including tiered network rules and gap exceptions, enabling them to help patients access the most appropriate and cost-effective services
• Knowledge of Appeals and Peer-to-Peer Reviews: The presentation outlines available pathways for addressing claim denials and medical necessity determinations, giving providers a clearer understanding of how to advocate for their patients when needed
• Reduced Administrative Frustration: By clarifying the responsibilities of providers, UMR, Health Link and patients, the video helps minimize confusion and streamline day-to-day health plan administration
• Access to Dedicated Support Resources: Physicians and office staff are connected with Plan Advisors and NMHS resources that can assist with portal navigation, prior authorizations, gap exceptions and other plan-related questions 

We hope you’ll find these resources useful in supporting our commitment to fostering strong provider partnerships, simplifying health plan administration and supporting high-quality, patient-centered care across the network.