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Welcome to the 2025 First Quarter edition of the MO HealthNet Provider Newsletter!
Our goal is to open the lines of communication between the MO HealthNet Division (MHD) and healthcare providers.
We're glad you're here!
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In This Edition:
MO HealthNet partnered with the MC Health Plans; Home State Health, Show Me Healthy Kids, Healthy Blue, and United HealthCare, to develop a universal NOP and Risk Screening Portal and NOP and Risk Screening Form. These resources will capture information about the patientās pregnancy and social determinants of health (SDOH).Ā
Here are the goals of this initiative:
- Centralized location for reporting the NOP and Risk Screening.
- Allow providers to report NOP and Risk Screening when the mother is pending eligibility or not enrolled in a Managed Care Plan.
- Use trusted relationships to capture high-priority information that Managed Care (MC) Health Plans and MHD consider relevant to determine what Social Determinants of Health (SDOH) supports are needed to improve health outcomes.
- Ensure information is timely, i.e., as early in the prenatal period as possible.
- Build collaborative relationships between providers and MC Health Plan case managers to support their patients/members.
- Create an opportunity for providers to share case management incentives and additional pregnancy related services and resources with mom.
- Advise mom to expect a call from the MC Health Plan, creating a warm hand-off between the provider and the plan.Ā
You can learn more about this process on the MHD Maternal and Infant Health webpage.Ā
To assist providers we have scheduled a live webinar on Tuesday, January 7, 2025 from 10:00 am to 11:00 am. Register here.
This a very new process so we donāt have statistics yet, but we will share those in future newsletters as they become available.
We hear you!Ā
We have received feedback that providers need more training on the Managed Care Health Plans' billing processes and portals. MO HealthNet Education and Training offers ongoing live webinars for providers on how to navigate our Fee For Service resources, proper billing methods, procedures for claim filing via eMOMED, and other requested topics
but now Healthy Blue, Home State Health, and United HealthCare trainings have been added to our MO HealthNet Provider Training calendar!
These trainings will provide portal, billing, updates, and program specific information. You can find the link to register for these trainings directly on our MO HealthNet Training Calendar. For additional trainings offered by the Managed Care Health Plans, review their training pages that are linked on the MO HealthNet Education and Training website.
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Provider Training Scheduled Posted, January ā March 2025
MHD Education and Training has posted theĀ 1st Quarter 2025 Provider Training Schedule. These live webinars can also be found on the Provider Training Calendar located on theĀ Education and TrainingĀ page.
We have added two new topics for webinars open to all MO HealthNet providers:
In-Person Workshops will continue! Our first of the new year will be for Hospice providers. More information will be posted soon.
We have also added trainings for our newest MO HealthNet providers,Ā Doulas.
For a recap of the information covered during our live webinars, review theĀ MO HealthNet Provider Overview Guide. Ā For additional resources refer to theĀ Education and Training Resources page.
EmailĀ MHD.Education@dss.mo.govĀ for more information.
The Automated IVR is coming!
The Automated Interactive Voice Response (IVR) is a self-service phone system that allows participants to engage with Family Support Division (FSD) through voice commands. Starting in mid-January 2025, participants will be able to complete the following over the phone without needing to talk to an FSD team member!
- Report changes
- Request a hearing
- Request a paper application
- Complete annual renewals for both MAGI and non-MAGI cases
- Submit Medicaid applications
- Submit SNAP mid-certifications
The IVR system will be accessible 24/7, providing participants the flexibility to manage these tasks at their convenience. Participants will access the IVR by calling the same 855-373-4636 number and then following the prompts for what they want to do.
MMAC and other key stakeholders have been hard at work to finalize a contract for a new Provider Enrollment System. This new system will be used for new provider enrollments, as well as revalidations. The new Enrollment system has an integrated (rather than stand-alone) Self-Service Portal to communicate with MMAC.Ā
As MMAC embraces new technology and to lessen the inconvenience for our providers, MMAC has discontinued the use of the Provider Communication Portal, which was launched in August 2024. MMAC is temporarily returning to our prior methods of communication with providers via email. Once the new Provider Enrollment System is prepared to go live, more information will be forthcoming.Ā Projected date for the new Enrollment System is mid-2026.
Thank you for your patience, as we seek the best technological advancements to best serve our providers and streamline the work for MMAC.
Backdate Requests for Denied Drug Claims
Providers are reminded of the policy regarding backdating requests for denied drug claims. The MO HealthNet Division (MHD) allows providers to request backdated claims in specific scenarios, including:
- When a participant is granted retroactive eligibility
- When a drug is administered in an emergency department (ED)
- On the first day of observation
- For time-sensitive emergency drugs dispensed from the "Emergency Kit" for emergency supply
However, backdate requests will not be approved if the claim was denied on the date of service and the pharmacy did not obtain the necessary override before dispensing the medication to the participant.
It is the provider's responsibility to verify the participant's MHD billing information before dispensing any medication. Providers who dispense drugs without a paid claim from MHD risk non-payment.
To request a backdate form, providers can email Pharmacy Administration at MHD.PharmacyAdmin@dss.mo.gov.
MO HealthNet Providers: Call Us For FREE!Ā
The Mo HealthNet Provider Communications Unit assists providers with eligibility and coverage verification, enrollment status, annual review dates, questions regarding proper claim filing, claims resolution and disposition, billing errors, verifying check amounts, and more.Ā
Providers are encouraged to communicate with Provider Communications using the Provider Communications Management tool inĀ eMOMED.Ā Providers may also call the Interactive Voice Response (IVR) system at (573) 751-2896.Ā
Providers can also call Provider Communications TOLL FREE at (833) 222-7916. The caller must have the providerās National Provider Identifier (NPI).Ā
The average wait time when calling Provider Communications is less than 70 seconds! Help us spread the word about our new toll-free number.
Crossover Claims
Mo HealthNet posted a provider bulletin on 09/19/2024, informing providers that a new feature has been added to eMOMED for Inpatient Crossover Claims. Effective June 16, 2024 a new āBilled Chargesā field was added into eMOMED for providers billing Inpatient Medicare Part A and C Crossover Claims.
This is a required field that must be entered when submitting Inpatient Crossover Claims into eMOMED. The provider bulletin provides instructions for submitting āBilled Chargesā, and examples where providers can locate this new field. Please see Provider Bulletin 47-22Ā for more information.
Look Who is Paying for Treatment Without Transport!
Certain emergency services are covered by the MO HealthNet Division (MHD) when the participant is not transported to an emergency department. This is referred to as Treat No Transport. A Treat No Transport call can include first responders providing patient care and dispensing medical supplies, but ultimately not transporting the participant to the hospital.
Ambulance providers may bill for Treat No Transport one time per day, per participant. Billing is easy and can reimburse with a maximum allowable amount up to $252.00.
Additional details can be found in the MHD Ambulance Treat No Transport Training. Additional resources for Treat No Transport and the Ambulance Program can be found on the MHD Ambulance Program page.Ā
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Dental Program Rate Increase
The MO HealthNet Division received approval from Centers for Medicare & Medicaid Services for the Dental Program Rate Increase State Plan Amendment to increase rates for dental anesthesia and extraction services.
Effective July 1, 2024, anesthesia codes were increased to 80% of the 50th percentile of the current National Dental Advisory Service Fee Report and extraction rates were increased to 38.5% of the 50th percentile of the same report. For additional information, please reference Bulletin 47-33.
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Effective December 22, 2024, the MO HealthNet Division (MHD) will accept POS 10 and 27 on Telemedicine claims. POS 10 indicates that services are provided to the patient in their home. POS 27 indicates that services are provided to the patient at an outreach site/street, such as a non-permanent location on the street or found environment.
Effective December 22, 2024, POS 02 will indicate that telemedicine services are being provided to a patient outside of their home, in a location such as a hospital or other facility.
This was announced in Bulletin 47-21 posted September 19, 2024.
Subscribe to MO HealthNet News to stay up to date on MHD policies, rate changes, and more.
On MO HealthNet News, you can filter by program or type of update, such as a bulletin, hot tip, or newsletter. You can also view all the Provider Newsletters on the news webpage.
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