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Qualified providers need to self-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 authority to continue reimbursing eligible providers, as determined by the Patient Protection and Affordable Care Act (PPACA), for an increased payment for certain primary care Evaluation and Management (E&M) and Vaccine Administration codes. DOM is extending the deadline for eligible providers to submit their 7/1/2016-6/30/2018 Self-Attestation Statement form to Xerox.  Effective July 1, 2016, reimbursement of certain primary care services provided by eligible providers will be at 100 percent of the Medicare Physician Fee Schedule. The DOM Primary Care Provider Fee Schedule is updated July 1 of each year based on 100 percent of the Medicare Physician Fee Schedule, which takes effect January 1 of each year.

How to Attest

To receive the increased payment for dates of service (DOS) beginning 7/1/2016, eligible providers must send a completed and signed 7/1/2016 – 6/30/2018 Self-Attestation Statement form to Xerox Provider Enrollment by 8/1/2016 through one of the following means:

Email: msinquiries@xerox.com
Fax: 888-495-8169
Postal mail: P. O. Box 23078, Jackson, MS 39225

Providers whose 7/1/2016-6/30/2018 Self-Attestation Statement forms are e-mailed, postmarked or faxed during the extension timeframe of 6/30/2016 – 8/1/2016, will experience a delay in the reimbursement of the increased payment, which will be retroactively adjusted. Providers must notify Xerox of any change(s) to their completed 7/1/2016-6/30/2018 Self-Attestation Statement form.  Providers can verify the processing of self-attestation statement forms they have submitted electronically by accessing the Envision Web Portal.

Self-Attestation Statement form

The 7/1/2016-6/30/2018 Self-Attestation Statement form is located on the DOM website and Envision Web Portal or can be requested by calling the Xerox Call Center toll-free at 800-884-3222.

Completed forms must be submitted to Xerox Provider Enrollment in one of the following ways:

Email: msinquiries@xerox.com
Fax: 888-495-8169
Postal mail: P. O. Box 23078, Jackson, MS 39225

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