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November 4, 2021
Provider Billing for the Adult Expansion Group (ME Code E2)
Effective October 1, 2021, individuals eligible for the Adult Expansion Group (AEG) are to be enrolled into the MO HealthNet Managed Care Program and assigned to one of the three contracted Managed Care Organizations. For any MO HealthNet coverage during the time period of July 1, 2021 to September 30, 2021, AEG participants are enrolled in the Fee-for-Service Program.
- Participant eligibility, including verification of enrollment with a MO HealthNet Managed Care Organization, should be verified through eMOMED.
- Claims for eligible dates of service of July 1, 2021 to September 30, 2021 should be billed as Fee-for-Service (billed to the state).
- Claims for eligible dates of service of October 1, 2021 and beyond are covered through the Managed Care Program and are to be billed to the Managed Care Plan to which the participant is assigned.
- Claims for services not included in the Managed Care Program such as pharmacy, for all participants, including AEG participants, are to be billed as fee-for-service (billed to the state).
- Prior quarter coverage for all participants, including AEG participants, is billed Fee-for-Service.
To access AEG FAQ’s please visit: Frequently Asked Questions: Adult Expansion for Providers | mydss.mo.gov
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