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Ordering/Referring/Prescribing Provider Enrollment

Ordering, Referring and Prescribing (ORP) Enrollment Application Instructions


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 Xerox at (800) 884-3222.