Project HepCure

The MO HealthNet Division (MHD) has awarded AbbVie a three-year contract to continue their collaboration on Project HepCure. This initiative provides MAVYRET®, a medication with a 98% cure rate, at no cost to MO HealthNet (Medicaid) enrollees.

Project HepCure focuses on eliminating hepatitis C by promoting early testing and treatment, particularly for high-risk groups. Despite 27,344 MO HealthNet participants being diagnosed with hepatitis C, only 6,606 have received treatment.

MHD Pharmacy Director Joshua Moore, PharmD, emphasizes the importance of prioritizing testing for all adults aged 18 and older. Dr. Blair Thedinger from KC Care Health Center praised the program, stating, “MO HealthNet’s Project HepCure has made accessing treatment for most of my patients so easy.”

Please take a moment to listen to this short video message from Josh Moore.

For more information, visit the Project HepCure webpage.

MO HealthNet / WIC Collaborative Efforts

Over the last six months, MHD and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) staff have worked closely together to increase uptake in WIC enrollment and participation for women and children on MO HealthNet (Medicaid), but not currently enrolled in WIC.

WIC provides supplemental food, health care referrals, nutrition education and breastfeeding promotion and support to eligible pregnant, breastfeeding and postpartum women, infants and children up to age five. Fathers, grandparents, guardians and foster parents may also apply for benefits for the children living in their household.

MHD sent text messages to participants currently enrolled in Medicaid but are not receiving WIC benefits, letting them know they can sign up for free food. There has been a 30% uptake in WIC benefits!

If you would like to refer a patient to WIC, you can share the following link so they can apply: health.mo.gov/living/families/wic

Continuous Improvement

A few years ago, MHD developed an Encounter Data Workgroup. This is a collaboration of staff from our actuary, Mercer, a representative from each Managed Care Organization (MCO) and various MHD team members. The goal of the group is to improve encounter data (claims submitted by the MCOs) for reporting purposes and rate setting. The team collects issues from stakeholders and determines how to best resolve them. Due to this collaborative effort, we now have very few encounter data issues.

The Encounter Data Workgroup sent out a survey to stakeholders and asked what else they needed from MHD. As a result of the responses, the workgroup has been working on two new encounter documents, described below.

1. One document explains encounter claim exceptions in detail to assist the MCOs. MHD has established a process with systems staff to notify us of changes so the document will be kept up to date.
2. The second document is a Managed Care Encounter Guide. This document is a one-stop shop for all things encounters. Providers will be able to find resources with links to websites, requirements for processes such as holding claims, when and how ad-hoc files are shared, links to provider manuals, contacts for MHD, and more.

Nursing Home Billing & Policy Workshop

MO HealthNet Education and Training is hosting an in-person Nursing Home Billing and Policy Workshop in Jefferson City. 

Nursing Home providers will have the opportunity to speak to the Department of Health and Senior Services (DHSS) Central Office Medical Review Unit (COMRU), the DHSS Certified Nurse Assistant Reimbursement Training Group, the Family Support Division (FSD) Vendor Unit, and the MO HealthNet Division (MHD) regarding required documentation, billing practices, resources, and more. There are 30 available seats left for this event.

Review the workshop agenda for more information. Register here.

When: August 27, 2024

Where: Governor Office Building, 200 Madison Street, Jefferson City MO

Time: 9am – 3:30pm

Recent Presentations

MO HealthNet Division Education & Training team presented at the Missouri Primary Care Association (MPCA) event on April 25, 2024. All four of MHD’s Education Specialists presented and received an evaluation of 4.5 out of 5 overall.

Some of the comments included:

• I learned about information that is given on the website that I was not aware and I plan to use it in the future.
• Spend down information was amazing.
• I was shown things in the eMOMED website that I had no clue were on there. That will be very useful.
• This was an amazing training! I love the updated website. I used to avoid it at all costs and I have already shared the new info with my coworkers.

Reach out to us at MHD.Education@dss.mo.gov to have a MHD Education Specialist present at your upcoming event!

Increased Reach

So far in 2024, MHD Education & Training has educated over 950 providers at our webinars. That is more than double this time last year! We want to be your resource for assistance with navigating our provider resources, proper billing methods, procedures for claim filing via eMOMED, and other requested MO HealthNet (Missouri Medicaid) topics.

Please join our Education Specialists for an upcoming webinar specific to your program by reviewing the Provider Training Calendar.

Providers in attendance have reported the following:

• Over 98% said the webinar was easy to fit into their schedules
• 81% of providers stated they were “very satisfied” with the Education Specialist who presented
• Over 73% were “very satisfied” and 21% were “satisfied” with the webinar overall

Premium Payments Return for Participants

The COVID-19 public health emergency put a pause on premium payments for patients with MO HealthNet coverage through the Children’s Health Insurance Program (CHIP), the Spend Down Program, and the Ticket to Work Program.

Beginning June 1, 2024, the pause ended. This means that premium payments (the amount these participants pay each month) have returned.

If you have patients with MO HealthNet coverage through CHIP, the Spend Down Program, or the Ticket to Work Program, please remind them that they will need to make a premium payment each month to continue their coverage.

Participants can make their premium payments online through the mymohealthportal.com, by automatic withdrawal, or by sending medical bills, checks, or money orders by mail. To learn more, visit the MO HealthNet premium payments FAQ webpage.

The Missouri Medicaid Audit & Compliance (MMAC) unit has been hard at work designing and building a new Provider Communications Portal which will become the primary way for providers and MMAC to exchange information and records.

MMAC contracted with Salesforce, a nationally recognized leader in helping businesses and government agencies employ technology to build strong, lasting customer relationships.  The project team has been making great progress and we hope to roll out the new Provider Communications Portal by the end of July 2026.

For providers, some of the many features of the new portal will include:

• The ability to update and maintain contact information; allowing for multiple contacts associated through account/contact relationships. and mailing information
• The ability to receive targeted emails for specific provider types
• The ability to receive text (SMS) messages
• The ability to upload documents
• The ability to submit a form and supporting documentation for loss or destruction of records
• The ability to submit any required quarterly/annual reports and audits
• The ability to submit enrollment forms and questions
• Creation of a “Help” section with program FAQs
• The ability to submit an anonymous complaint or fraud referral

From MMAC’s perspective, the new portal will allow our team to send you emails or text messages (optional) advising you have important program information in the portal awaiting your retrieval.  It will also allow MMAC to send courtesy reminders to providers, such as when the due date for your five-year revalidation is approaching or when a required quarterly or annual report is due.

The MMAC team is very excited about the new portal and look forward to it becoming a much more efficient and accountable way for us to communicate with you.

Quick Reference Guide for Mailing Paper Claims and Forms

If you're mailing in paper claims and forms, make sure you have the correct address! We've provided a quick reference guide below. You can also find this information in each relevant provider manual.

Ambulance Billing

Recently, we noticed some providers have been billing procedure code A0428 (Ambulance service, Basic Life Support (BLS) non-emergency transport) without the appropriate modifiers. 

We created a new Hot Tip to address this.

Procedure Code A428 (Ambulance service, Basic Life Support (BLS) non-emergency transport) should only be billed in the following circumstances:

• Transfer from one hospital to another (modifier HH)
• Transfer from a hospital to a diagnostic or therapeutic site (modifier HD)

For more information, refer to the Ambulance Manual.

Automatic External Defibrillator Garment Coverage

MHD made a decision to cover automatic external defibrillator garments for adults through the DME pre-certification process. Previously, these items were available for adults through the Exceptions process only. The criteria established in the DME Pre-Certification Criteria Document on MO HealthNet’s website must be met to be approved.

Free Standing Birth Centers

Free Standing Birth Centers received a rate increase effective March 1, 2024. Please refer to Bulletin 46-48 for more information.  

Hospital Dental Billing

 A Hot Tip was created to remind hospital providers to use the Current Dental Terminology© (CDT) codes included on the MHD Fee Schedule under Outpatient Hospital to receive maximum reimbursement for dental services performed in the outpatient setting. If providers bill the appropriate CDT procedure codes instead of only billing 41899 they could potentially receive a much higher reimbursement.

Outpatient Observation Billing 

A Hot Tip was created to address provider questions on proper observation billing. MHD supplied hospital providers with language from the Hospital Provider Manual and additional information about billing observation charges after the 24 hour period of observation had expired. In the Hot Tip we supplied examples and links to the CMS-1450 (UB-04) claim form, eMOMED, the hospital manual, MHD Fee Schedules, and Medicare's policy.

Revised Dental Bulletin

Expansion of Silver Diamine Fluoride (SDF) was implemented April 1, 2024. SDF is now covered when medically necessary for all kids ages 0-20, blind, pregnant, and nursing home participants.

A revised Dental Bulletin was published to clarify policy related to what criteria should be met in order for a participant to receive Silver Diamine Fluoride (SDF).

MHD considers SDF medically necessary when the participant meets any of the following conditions:

• Documented high caries-risk patient with anterior or posterior active cavitated lesions in primary or permanent teeth; or
• Presence of cavitated carious lesions in patients with well documented behavioral or medical management challenges; or
• Presence of carious lesions not able to be accessed and restored through conventional treatment; or
• Patient has no means to access regular routine care; or
• Presence of active cavitated carious lesions with no clinical signs of pulpal involvement

Revised Occupational Therapy for Behavioral Health Conditions 

A revised Occupational Therapy for Behavioral Health Conditions Bulletin was published due to the unintentional omittance of a code within the table in the bulletin.  Procedure code 97169 for unlisted therapeutic procedures was added in this revised Bulletin.

Updated Breast Pump Bulletin

Exciting news! Pregnant women with MO HealthNet Fee-For-Service coverage can now receive a breast pump.

As part of MHD’s Maternal and Infant Health Initiative, the decision to was made allow reimbursement for manual and electric breast pumps.  Participants must be in their third term of pregnancy to qualify for coverage. Prior authorization is not required. Participants are limited to one manual or one electric pump per lifetime. 

For participants in a Managed Care plan, they should contact their Plan for information regarding a free breast pump.

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On the MO HealthNet News webpage, you can filter by program or type of update, such as a bulletin, hot tip, or newsletter. That's right! You can also view all of the Provider Newsletters on the news webpage.