23 Miss. Code. R. 203-8.1 - Physician Assistant Enrollment Requirements

A. Physician assistants (PAs), who are licensed by the Mississippi State Board of Medical Licensure, and are practicing with physician supervision under regulations adopted by the board, may participate in the Mississippi Medicaid Program upon compliance with provider enrollment requirements outlined in Part 200, Chapter 4, Rule 4.8 in addition to providing the following:

1. National Provider Identifier (NPI), verification from National Plan and Provider Enumeration System (NPPES),

2. Copy of current licensure card,

3. Verification of social security number using a social security card or driver's license if it notes the social security number, military ID or a notarized statement signed by the provider noting the social security number. The name noted on verification must match the name noted on the W-9,

4. Copy of approved protocol and practice setting,

5. The name and Mississippi Medicaid provider number of the PA's supervising physician, and

6. Copy of specialty certificate(s), if applicable.

B. The PA's supervising/collaborating physician must be enrolled with Mississippi Medicaid as:

1. A Medicaid provider, or

2. An Ordering, Referring or Prescribing (ORP) physician.

Notes

23 Miss. Code. R. 203-8.1

42 C.F.R. Part 455, Subpart E; Miss. Code Ann. §§ 43-13-117, 43-13-121.

Amended 12/1/2019