23 Miss. Code. R. 207-4.2 - Provider Enrollment

Enrollment into the Medicaid program requires each provider to comply with the requirements outlined Part 200, Chapter 4, Rule 4.8, in addition to the following provider type specific requirements:

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

B. Board of Director's (Commissioner's) Resolution form, letter of signature authority, or copy of minutes indicating signature authority.

C. Written confirmation from the IRS confirming your tax identification number and legal business name.

D. CLIA certificate and completed certification form.

E. Joint Commission on Accreditation of Health Care Organization (JCAHO) or Council on Accreditation (COA) accreditation.

Notes

23 Miss. Code. R. 207-4.2

Miss. Code Ann. § 43-13-121; 43-13-117; 43-13-118; 43-13-129; 42 CFR 441, Subpart D; 42 CFR 441.151