Terms of Usage
Privacy Policy
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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 |
| New policy concerning Out of State enrollment and Effective Date of Provider Agreement is located in the Division of Medicaid's Admin Code Title 23, Part 200, Chapter 4, Rule 4.2 (B) and Rule 4.4 located at www.medicaid.ms.gov/providers/administrative-code. |
| 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 |
| 4) Effective from 01/01/2020, all Out of State enrolling providers are also required to submit the Provider Application Cover Letter. Click here to download the cover letter. |
| Click here to download an application. |
| Online Instructions |
| New policy concerning Out of State enrollment and Effective Date of Provider Agreement is located in the Division of Medicaid's Admin Code Title 23, Part 200, Chapter 4, Rule 4.2 (B) and Rule 4.4 located at www.medicaid.ms.gov/providers/administrative-code. |
| 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 |
| 4) Effective from 01/01/2020, all Out of State enrolling providers are also required to submit the Provider Application Cover Letter. Click here to download the cover letter. |
| Click here to enroll online. |
| If you have any questions concerning this application, please contact Conduent at (800) 884-3222. |
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