19 MAC Pt. 3, R. 11.07
Uniform Application for Physician Credentialing and Recredentialing
Cite as 19 Miss. Admin. Code Pt. 3, R. 11.07
Uniform Application for Physician Credentialing and Recredentialing
A. In order to simplify the application process for physicians who are applying to multiple
managed care entities, the Commissioner hereby adopts a basic uniform credentialing
application which shall be used by all managed care entities performing physician
credentialing and recredentialing activities in Mississippi. The uniform application is
attached hereto as Exhibit “A” and hereby made a part of this Regulation.
B. The uniform application may be augmented by an individual managed care entity for the
purpose of obtaining additional necessary and material information which is not
requested in the uniform application, and further, for the purpose of providing more
detailed instructions regarding the completion and submission of the application. The
additional information/instructions may only be requested/provided on supplemental
sheets which are attached to the uniform application. Any proposed supplemental sheets
must be submitted by the managed care entity to the Commissioner for prior approval.
C. The form prescribed by this Section shall apply only to the credentialing and
recredentialing of physicians.