Rule 23-202-1.2 - Provider EnrollmentHospital providers, including psychiatric hospitals and swing bed providers applying for enrollment into the Medicaid program must satisfy all requirements set forth in 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. Written confirmation from the IRS confirming your tax identification number and legal business name.C. CLIA certificate and completed certification form.D. Licensed freestanding psychiatric hospitals must submit Joint Commission on Accreditation of Health Care Organization (JCAHO).E. Copy of current Medicare certification or Tie-In Notice. EOMB is not acceptable.F. Out of state facility: Copy of outstanding claims, if applicable.G. Copy of hospital license1. Out-of-state facility: Copy of license/certification in effect during the claims period for which they are billing.2. In-state facility: A copy of letter from the Mississippi State Department of Health is acceptable.3. Hospital undergoing a Change of Ownership (CHOW): License in effect for the new owner.23 Miss. Code. R. 202-1.2
Miss. Code Ann. § 43-13-121; 42 CFR §482.11