Mississippi Medicaid Provider Disclosure Form - Mississippi

Mississippi Medicaid Provider Disclosure Form is a legal document that was released by the Mississippi Division of Medicaid - a government authority operating within Mississippi.

FAQ

Q: What is the Mississippi Medicaid Provider Disclosure Form?
A: The Mississippi Medicaid Provider Disclosure Form is a document that providers must complete to disclose certain information when enrolling or revalidating as a Medicaid provider in Mississippi.

Q: Who needs to complete the Mississippi Medicaid Provider Disclosure Form?
A: Any provider who is enrolling or revalidating as a Medicaid provider in Mississippi needs to complete the form.

Q: What information is required on the Mississippi Medicaid Provider Disclosure Form?
A: The form requires providers to disclose information such as ownership, control, and affiliation with other providers or entities, as well as any disciplinary actions or exclusions from other healthcare programs.

Q: Is there a deadline for submitting the Mississippi Medicaid Provider Disclosure Form?
A: The form should be submitted at the time of enrollment or revalidation as a Medicaid provider, according to the specified guidelines and deadlines set by the Mississippi Division of Medicaid.

Q: What happens if I don't disclose the required information on the Mississippi Medicaid Provider Disclosure Form?
A: Failure to provide accurate and complete disclosure may result in delays or denial of enrollment or revalidation as a Medicaid provider, and may also lead to potential penalties or sanctions.

Q: Do I need to submit the Mississippi Medicaid Provider Disclosure Form every time I revalidate as a Medicaid provider?
A: Yes, the form should be submitted with each revalidation application to ensure that the Medicaid program has up-to-date information about the provider.

Q: Can I make changes to the information provided on the Mississippi Medicaid Provider Disclosure Form after it has been submitted?
A: Yes, providers can update or amend their disclosures by submitting a revised form or notifying the Medicaid provider enrollment unit of the changes.

Q: Are there any fees associated with the Mississippi Medicaid Provider Disclosure Form?
A: No, there are no fees specifically associated with the completion and submission of the Mississippi Medicaid Provider Disclosure Form.