Terms of Usage
Privacy Policy
Contact Us
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Terms of Usage
Privacy Policy
Contact Us
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| This application is for the sole purpose of ordering/referring/prescribing items and services for MS Medicaid beneficiaries. This type of enrollment does not allow MS Medicaid to reimburse the applicant/provider for services provided. If the applicant/provider wishes to be reimbursed for services performed, he/she must submit a full application package as required by MS Medicaid. |
| Paper Application Instructions |
| Complete all sections of the Ordering, Referring and Prescribing (ORP) application. |
| Application must be signed by the enrolling provider. |
| This application will not be accepted if any portion has been filled out incorrectly or forms/documents are not completed and/or missing. |
| Keep a copy of this application for your records. |
| The ORP application may be submitted via online or mail. |
| The mailing address is: | Mississippi Medicaid Program |
| Provider Enrollment P O. Box 23078 Jackson, MS. 39225 |
| Required Documentation: |
| 1) Mississippi Medicaid Enrollment Application Ordering, Referring and Prescribing (ORP) |
| 2) Copy of Current License for servicing state |
| 3) Verification of National Provider Identifier (NPI) from the NPPES website |
| Click here to download an application. |
| Online Instructions |
| Complete all sections of the Ordering, Referring and Prescribing (ORP) application. |
| Application must be signed by the enrolling provider. |
| This application will not be accepted if any portion has been filled out incorrectly or forms/documents are not completed and/or missing. |
| Keep a copy of this application for your records. |
| If the provider is completing the ORP Enrollment Application through online, all required/supporting documents must be uploaded through the online. |
| The ORP application may be submitted via online or mail. |
| Required Documentation: |
| 1) Ordering, Referring and Prescribing Application (ORP) signature page |
| 2) Copy of Current License for servicing state |
| 3) Verification of National Provider Identifier (NPI) from the NPPES website |
| Click here to enroll online. |
| If you have any questions concerning this application, please contact Conduent at (800) 884-3222. |
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