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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 102 – Non-Financial Requirements Page |95 • Complete Form DOM-325, Disability Determination and Transmittal. This form serves as the transmittal form for submitting DOM-323, DOM-323A and DOM-324, if applicable, medical releases and prior medical information from the case record. o If the individual is applying under the Working Disabled coverage group, this should be clearly indicated in “Remarks”. o If the applicant is a child, put the parent or representative’s name on the DOM-325 in the same space with the case name. o For example, enter Jane Doe (parent) for Janie Doe. Submission to DDS Include all material discussed above in a file folder labeled with the client’s name, Social Security Number and case number: Jane Doe 425-45-9999 300-74-8855 Mail the folder to DDS as follows: Disability Determination Service P O Box 1271 Jackson, MS 39205 Timeframes For initial DDS submissions and re-submissions, the worker should set an alert for 90 days. If a disability decision is not received within 90 days or if any problem occurs pertaining to the medical decision the regional bureau director should be notified to contact DDS. The DDS toll free telephone number is: (800) 962-2230. The local DDS telephone number is (601) 853-5100. Procedures for Receiving DDS Decisions and Reevaluations • DDS will return the medical information file and a disability or blindness decision to the regional office. The decision will be recorded on the lower portion of the DOM- 325. Any 325 that does not have physician’s signature should have a physician’s rating referenced in the “Remarks” section. • DDS will attach this cross-referenced documentation to the 325. Each regional office will ensure DDS sends all relevant material for a decision. • When an approved DOM-325 is received, the need for a re-examination and date is indicated in section 15. If no re-examination is needed, the DOM-325 is valid Effective Month: July 2025