New Year, New Look!

MHD launched a new website. The new site was designed to be more user-friendly by updating the layout, design, content, and functionality.

The MHD Education and Training team will be holding webinars to help providers navigate the new website.

Please check the Education and Training webpage to find a training applicable to your program. 

With the launch of the redesigned website, we created a Master List of Covered Services to complement the Benefit Tables. These resources are an overview of the benefits and limitations for each MHD program. Providers should always refer to specific Provider Manuals for additional program information.

MHD Education & Training

MHD Education and Training is here to help providers. Please visit our Education & Training page.

If there is a resource you need or a current resource that we could improve upon, please let us know by emailing MHD.Education@dss.mo.gov.

Join a program specific webinar to learn about navigating provider resources and billing.

Print off our quarterly schedule and post for your office staff!

To schedule one-on-one or a training for your office staff, contact us at MHD.Education@dss.mo.gov or call (573) 751-6683, option 1.

Additional Vaccine for RSV

The Department of Health and Senior Services (DHSS) is now offering an additional vaccine to providers enrolled in the Vaccines for Children (VFC) program. MHD reimburses for the administration of Beyfortus, a long-acting monoclonal antibody product, for use in newborns and infants to protect against Respiratory Syncytial Virus (RSV). 

For questions or to confirm eligibility, contact Provider Communications at (573) 751-6683 or via the secure direct messaging option in eMOMED. 

Primary Care Health Homes

MO HealthNet has previously reimbursed as the primary payer for services provided by licensed professional counselors (LPC) and licensed marital & family therapists (LMFT) for Medicare participants.

As of January 1, 2024, Medicare has begun covering services provided by these provider types.

MO HealthNet will be implementing system work to ensure that Medicare pays primary when services are rendered by LPCs and LMFTs.

A bulletin will be sent to MO HealthNet providers when this system work is complete.

MO HealthNet's Non-Emergency Medical Transportation (NEMT) Program assures transportation to Medicaid eligible participants who do not have access to free appropriate transportation to and from scheduled MO HealthNet covered services.   

MTM has implemented a new policy for gas mileage reimbursement (GMR) trips for participants seeking NEMT services through the MO HealthNet Fee for Service (FFS) Program. GMR trips that are 25 miles or greater will require a reservation by phone. GMR trips under 25 miles (distance from the participant’s home to the medical provider), will not be affected by this change. Trips are subject to verification by MTM and will still require a provider signature on the travel form.

Review the NEMT Overview for the basics on this benefit.

For more information on the NEMT Program, visit the NEMT Provider page.

For information for your participants, print the NEMT flyer.

Introducing Healthy Moms, Healthy Babies

Healthy Moms, Healthy Babies is a new website with the goal to consolidate education and resources in a single location for mothers and healthcare providers.

MHD created the site in collaboration with DHSS, the Department of Mental Health (DMH) and the Department of Elementary and Secondary Education (DESE) in order to achieve better outcomes by connecting women to quality healthcare and supportive resources to help ensure healthy, successful pregnancy and post-partum experiences for mom and baby.

Postpartum Healthcare Coverage Extension

Beginning July 7, 2023, MO HealthNet coverage for pregnant and postpartum women was extended to a full year following the end of pregnancy. For your patient’s questions regarding eligibility, have them contact the Family Support Division at (855) 373-4636.

“Federal approval of the 12-month postpartum coverage is an important step toward improving health outcomes for moms in the state of Missouri,” said Todd Richardson, Director, MO HealthNet. “With nearly 50 percent of births in Missouri on MO HealthNet we want to make sure that mothers have the ability to take care of their own health as well as the health of their babies.”

For questions or to confirm eligibility, contact Provider Communications at (573) 751-6683 or via the secure direct messaging option in eMOMED.  

Group Prenatal Care

Effective for dates of service on or after December 1, 2023, MHD implemented coverage for Group Prenatal Care. GPC has demonstrated a reduction in preterm birth, neonatal intensive care unit (NICU) admissions; increased birth weight for term and preterm infants; increased rates of breastfeeding initiation and continuation; decreased emergency department visits in the third trimester; improved pregnancy-related weight management; an increase in patients presenting in active labor and at greater cervical dilatation; increased patient, obstetrician and other obstetric care provider satisfaction; and improved knowledge of childbirth, family planning, postpartum depression, and early child rearing.

For more information, please read the Group Prenatal Care Bulletin 46-31.

Reporting a Pregnancy to MHD Made Easy!

MO HealthNet participants who report a pregnancy to the MO HealthNet Division (MHD) are eligible for a wide variety of additional benefits.

Review Healthcare Services for Pregnant Women for more information on these benefits and share this flyer with your patients.

Effective November 21, 2023, reporting a pregnancy through the Report A Change website has been simplified. Now the participant has the option to choose “Do you need to report a pregnancy?” and complete three easy questions.

Participants can also report a pregnancy by calling FSD at (855) 373-4636 or they can visit their local Resource Center.

Upon learning a participant is pregnant, please share these options with them so they are able to take full advantage of the benefits available to them.

Managed Care Plan Benefits for Maternal and Infant Health

MHD would like to thank the providers who joined us on November 13, 2023 and March 26, 2024, for the Optimizing Missouri’s Managed Care Plan Benefits for Maternal and Infant Health meetings. MHD would like to provide the valuable information that was shared at this meeting with all providers.

You can review information on available benefits for pregnant women and their infants from Healthy Blue, Home State Health, United HealthCare, Show Me Healthy Kids, and MHD.

Watch MO HealthNet News for additional upcoming meetings.

MO HealthNet Annual Renewals Continue

Remember to share with your Medicaid patients that MO HealthNet annual renewals have returned. Remind them in order to keep their coverage they need to complete their annual renewal.

Your patients can create an account on the FSD Benefits Portal to check when their annual renewal is due. They can complete their annual renewal online in the FSD Benefits Portal, in person at their local FSD Resource Center, by calling 855-373-4636, or by mail to the address shown on their letter.

Check out the annual renewal dashboard to see the progress being made on MO HealthNet annual renewals.

MHD recently reached 73,000 enrolled healthcare providers. Missouri Medicaid Audit and Compliance (MMAC) enrolls the providers and has seen an increase of approximately 3,000 additional providers per year over the last six years. MMAC enrolls 65 different types of providers with a number of specialties within most provider types.

During the past legislative session, MMAC was authorized 10 additional full-time positions which equated to five more auditors, four provider enrollment staff, and one additional investigator. The additional staff will help MMAC keep up with the increased number of enrollment applications, audits, and investigations needed to maintain the integrity of Missouri’s Medicaid program.

Also during this past legislative season, MMAC received budget authority to proceed with implementation of a 100% electronic provider enrollment system. MMAC currently has a hybrid enrollment system which allows for electronic enrollment for some provider types, but still relies on paper applications, emails, and faxes for some.

The new provider enrollment system will have robust self-service features so providers that are updating something simple like a new address, telephone number, or email will be able to make those changes themselves. There will be a call center available during business hours with staff to answer provider questions or provide other needed help. The new system will provide for a much better customer experience and quicker turnaround times for the approvals of new applications and five-year enrollment revalidations.

MMAC is currently in the process of identifying the vendor that will implement and operate the new system. The kick-off for the Design, Development and Implementation (DDI) phase is scheduled to occur in April 2024. Implementation is estimated to take approximately 18 months, with the new enrollment system operational in mid to late 2025.

The Centers for Medicare & Medicaid Services (CMS), in partnership with the states, is measuring improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs through their Payment Error Rate Measurement (PERM) process

CMS and its PERM contractors will send records requests directly to Missouri Medicaid/CHIP providers for claims billed during state fiscal year 2024. Additional information about the PERM program is addressed on the CMS PERM website. Refer to the “Providers” link on the website.

Federal regulations require that Medicaid/CHIP providers submit the medical record documentation to support claims for Medicaid/CHIP services to CMS upon request. Providing medical records for Medicaid/CHIP patients does not violate the Health Insurance Portability and Accountability Act (HIPAA). Patient authorization is not required to respond to this request. CMS and its contractors will comply with the Privacy Act federal regulations governing the sharing and transmission of Protected Health Information (PHI).

Questions regarding the PERM audit may be directed to the State PERM representative Joyce Chandler at 573-751-7993 or please email MMAC.PERMaudits@dss.mo.gov.

Update Your Provider Information

If you are a MO HealthNet Provider and need to update your contact information, location, change of ownership, etc., please complete a Provider Update Request.

The completed form can be faxed to (573) 634-3105 or emailed to MMAC.ProviderEnrollment@dss.mo.gov.

Home and Community Based Services (HCBS) providers should complete the HCBS Change Request to make necessary updates and fax the completed form to (573) 634-3105.

Provider Enrollment Tip

If you have questions or need assistance completing MO HealthNet provider enrollment forms, contact the Provider Enrollment Unit at MMAC.ProviderEnrollment@dss.mo.gov.  

If you have technical problems, contact the Help Desk at 573-635-3559. 

Dental Program

Most claims filed by MO HealthNet dental providers can be submitted via eMOMED. However, dental providers submitting claims for MO HealthNet Fee-for-Service (FFS) participants that require additional documentation to be submitted (i.e., x-rays) should be submitted on paper dental claim forms.

In order for these forms to be processed for payment, the forms must be mailed directly to:
Wipro Infocrossing
P.O. Box 5600
Jefferson City, MO 65102

To determine if additional documentation is necessary when submitting a dental claim, refer to the table in Section 5 of the Dental Provider Manual.

For more information regarding filing dental claims, reference Section 4.5 of the Dental Provider Manual.

Project Hep Cure

Project Hep Cure is an initiative to cure hepatitis C by making prescription MAVYRET® available to MO HealthNet participants at no cost.

MAVYRET® is an 8-week treatment that is proven to cure hepatitis C 98% of the time. Anyone who has MO HealthNet coverage and has tested positive for hepatitis C is eligible for treatment.

For more information on this important initiative, visit Project Hep Cure.

Durable Medical Equipment Program

MO HealthNet Durable Medical Equipment (DME) providers must use the appropriate HCPCS code from the MO HealthNet Fee Schedule for specific items.  If there is not an item-specific HCPCS code on the fee schedule as payable, it may be appropriate to use a miscellaneous code.

For example: 
If ordering a gait trainer for a child, choose the appropriate code from the MO HealthNet Fee Schedule:

E8000 EP – Gait Trainer, Ped Sz, Posterior Support, Includes All Accessories

E8001 EP – Gait Trainer, Ped Sz, Upright Support, Includes All Accessories

E8002 EP – Gait Trainer, Ped Sz, Anterior Support, Includes All Accessories

For more information on miscellaneous codes, refer to Section 5 of the DME Provider Manual.

If you have questions on how to use the MO HealthNet Fee Schedule, review the General Provider Resource Overview, or register for a training on the Education and Training page.