Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 4 - Provider Enrollment › Rule 23-200-4.1 - Definitions

Current through June 25, 2024
A. Providers: All health care entities
				including individual practitioners, institutional providers, and providers of
				medical equipment or goods related to care that are currently enrolled in the
				Medicaid program.
B. National
				Provider Identifier (NPI): A Health Insurance Portability and Accountability
				Act (HIPAA) Administrative Simplification Standard. The NPI is a unique
				identification number for covered health care providers as noted in 45 C.F.R.
				§ 162. Covered health care providers and all health plans and health care
				clearinghouses must use the NPIs in the administrative and financial
				transactions adopted under HIPAA.
C. Sole Proprietor: A Sole Proprietor is a
				form of business in which one (1) person owns all of the assets of the business
				and is solely liable for all debts on an individual basis. As a result of the
				National Provider Identifier (NPI) requirements, a Sole Proprietor must apply
				for their NPI as individuals. Medicaid will no longer issue a group number to
				an individual effective with the adoption of this rule revision. The subpart
				concept does not apply to a sole proprietorship, even one (1) with multiple
				locations, because the sole proprietorship is not an organization as defined in
				the final NPI Rule. An individual Medicaid provider number and the appropriate
				NPI issued by the Centers for Medicare & Medicaid Services (CMS) are
				entered into the Medicaid system with the individual's social security number
				(SSN); and if applicable, the Federal Employer Identification Number (FEIN)
				assigned to it. If this number is used as a Medicaid provider billing number,
				income or earnings information are reported to the IRS for this SSN or FEIN, as
				applicable. Deferred compensation is only available via a sole proprietor's
				SSN.
D. Group/Organization: A
				Group/Organization provider is not an individual/sole proprietor. This may
				include hospitals, long-term care facilities, laboratories, home health
				agencies, ambulance companies, and group practices; suppliers of durable
				medical equipment or pharmacies. Any subpart of the group/organization must
				apply for a different Medicaid provider number as determined by the provider
				type per Medicaid rule. A group provider requesting individual
				providers/servicing providers to be affiliated to their billing provider number
				must be approved Medicaid providers. For monies to be reported to the IRS on
				its Tax Identification, the group provider should be the biller, unless
				otherwise restricted by the Division of Medicaid. Group providers that have
				various servicing locations should apply to Medicaid to become a provider
				according to their enumeration application with CMS. The provider should also
				apply to Medicaid to become a provider according to the conduct of their own
				standard transactions and as required by the Division of Medicaid's program
				rules.
E. Effective Date: The
				earliest date a provider may begin billing for services.
F. Officer: Any person whose position is
				listed as being that of an officer in the provider's "articles of
				incorporation" or "corporate bylaws" or anyone who is appointed by the board of
				directors as an officer in accordance with the provider's corporate bylaws.
G. Director: A member of the
				provider's "board of directors." It does not necessarily include a person who
				may have the word "director" in his/her job title. Moreover, where a provider
				has a governing body that does not use the term "board of directors," the
				members of that governing body will still be considered "director". Thus, if
				the provider has a governing body titled "board of trustees," as opposed to
				"board of directors," the individual trustees are considered "directors" for
				Medicaid enrollment purposes.
H.
				Managing/Directing Employee: A managing/directing employee may be a general
				manager, business manager, administrator, director, or other individual who
				exercises operational or managerial control over, or who directly or indirectly
				conducts, the day-to-day operations of the entity, either under contract or
				through some other arrangement, regardless of whether the individual is a W-2
				employee of the entity.
I.
				Authorized Official: An appointed official to whom the organization has granted
				the legal authority to enroll it in the Medicaid program, to make changes or
				updates to the organization's status in the Medicaid program, and to commit the
				organization to fully abide by the statutes, regulations, and program
				instructions of the Medicaid program. Examples include: chief executive
				officer, chief financial officer, general partner, chairman of the board, or
				direct owner.
J. Delegated
				Official: An individual who is delegated by an authorized official with the
				authority to report changes and updates to the entity's enrollment record. A
				delegated official must be an individual with an "ownership or control
				interest," or be a W-2 managing employee of the entity. Documentation in the
				application or as an attachment must be included with the application. A change
				of a delegated official will only be made to the file with the appropriate
				documentation signed by a documented authorized official.
K. Majority Interest: Ownership interest
				greater than fifty percent (50%) of the voting interest in a business
				enterprise.
42 C.F.R. Part 455,
				  Subpart E; Miss. Code Ann. §§
										43-13-117,
				  43-13-121.