Click to submit a request for Public Records
The General Counsel of Mississippi Division of Medicaid has oversight of the Public Records Office.
Mississippi Division of Medicaid is committed to the accurate sharing of non-exempt public records, in accordance with agency policies. All records and portions of records, not exempt from disclosure, will be made available in accordance with the procedures outlined in the agency’s policy adopted in compliance with –
• Mississippi Public Records Act of 1983, Miss. Code Ann. §25-61-1 thru 25-61-19.
• Mississippi Ethics Commission’s Model for Public Records Rules; and
• Title 23, Part 100, Chapter 9, Rule 9.2 of the Mississippi Administrative Code.
Contact information for the public records officer:
Mississippi Division of Medicaid
Attn: Public Records Officer
P.O. Box 2222
Jackson, MS 39225
Email: public.records@medicaid.ms.gov
All requests to examine, copy, or obtain public records, not found on the Mississippi Division of Medicaid’s website should be in writing and submitted using the Public Records Request Form at the link above. The request should provide as much detail as possible about the records requested that would assist in identifying the record, including the preferred format (paper copy, electronic delivery, or inspection) and must include the name, address, and contact information (email address and phone number) of the requestor.
Requests for Information and HIPAA
DOM processes any type of public records request in compliance with the Health Insurance Portability and Accountability Act (HIPAA), as amended, and any other applicable state and federal laws regarding the privacy and security of information. Additionally, the Privacy Officer will be consulted when necessary. The DOM Public Records Officer is responsible for notifying the requestor if, and when, additional information or forms are needed for release of permissible protected health information (PHI). Learn more about HIPAA and DOM’s Notice of Privacy Practices.
Claims Payment and Lien Requests
Attorneys and Third-Party Authorized requestors requesting claims payment information and Mississippi Division of Medicaid lien amounts for DOM members may complete the form linked below.
Be sure to include a complete and signed Authorization for the Use/Disclosure of Protected Health Information with your electronic request.
• Authorization for Use/Disclosure of Protected Health Information
Member Records Requests
Mississippi Division of Medicaid Members or their Authorized Representatives may request their own Medicaid claims or eligibility documentation utilizing the form linked below.
Please have a copy of the Member’s state issued photo id card available to submit as an attachment. You may take a photo of your photo id and upload it from your device to the form linked below.
If you are requesting information on behalf of a member and need to complete an authorization form, please print and fill out the form linked here. You may submit the authorization as an attachment to the Subrogation Request Form.
• Authorization for Use/Disclosure of Protected Health Information
