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Qualified providers must attest/re-attest to receive increased primary care services payments

Pursuant to Miss. Code Ann. §§ 43-13-117, 43-13-121, the Mississippi Division of Medicaid (DOM) was granted the authority to continue reimbursing eligible providers at 100 percent (100%) of the Medicare Physician Fee Schedule for certain primary care Evaluation and Management (E&M) and Vaccine Administration codes. To receive the increased payment for dates of service (DOS) beginning 7/1/2021, eligible providers must attest to one (1) of the following:

1) Physician is board certified by the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS), American Congress of Obstetricians and Gynecologists (ACOG), the American Osteopathic Association (AOA) as a specialist or subspecialist in obstetric/gynecologic medicine, or

2) Physician with a primary specialty designation in family medicine, general internal medicine, pediatric medicine, obstetric/gynecologic medicine, and sixty (60%) of their total Medicaid paid codes for the previous Calendar year was for specified Evaluation & Management (E&M) or Vaccine Administration codes, or

3) Physician, newly enrolled as a Medicaid provider, with a primary specialty/subspecialty designation and attests that certain primary care E&M and Vaccine Administration codes will equal at least sixty percent (60%) of the Medicaid codes they will bill during the attestation period, or

4) Non-physician practitioner providing primary care services in a Practice Agreement with a qualified physician enrolled for increased primary care services.

How to Attest

To receive the increased payment for certain primary care and vaccine administration services provided for dates of service (DOS) beginning 7/1/2021, eligible providers must send a completed and signed 7/1/2021 – 6/30/2024 Self-Attestation Statement form to Conduent Provider Enrollment by 6/30/2021. Providers, whose forms are received after 5/31/2021, may experience a delay in processing which may impact increased payment reimbursement. Providers must notify Conduent of any change(s) to their completed 7/1/2021-6/30/2021 Self-Attestation Statement form.  Providers can verify the processing of self-attestation statement forms they have submitted electronically by accessing the Envision Web Portal.  To receive the increased payment, eligible providers must send a completed and signed 7/1/2021-6/30/2024 Self-Attestation form to Conduent Provider Enrollment through one of the following means:

  • Email:
  • Fax: 888-495-8169
  • Postal mail: Conduent Provider Enrollment, P. O. Box 23078, Jackson, MS 39225

Self-Attestation Statement form

The 7/1/2021-6/30/2024 Self-Attestation Statement form is located on the DOM website and Envision Web Portal or can be requested by calling the Conduent Call Center toll-free at 800-884-3222.