Application to Become an Approved Provider 2021-03-15T12:26:12+00:00

Application to Become an Approved Provider

Download the Application


After downloading the application, please complete and send it along with the appropriate documentation to 

  • Online via Service Request
  • Mail via: P.O. Box 352, Jackson, MS 39205
  • Fax via: 601.359.4422

When the application is processed, you will receive a confirmation email with your Provider ID. 


Attend a provider e-Ledger training webinar (Online Training) held on the first and third Tuesday of every month at 12:30 p.m. You must register in advance and attend the entire session to receive credit for attendance.

E-Ledger Training
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