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Thanks for reading 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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MHD Launches Inaugural Beneficiary Advisory Council
 On August 28, 2025, MHD marked a significant milestone with the inaugural meeting of its Beneficiary Advisory Council (BAC). This council was established in accordance with the Centers for Medicare & Medicaid Services (CMS) Final Rule 89-40542.
MHD's council is known as the MO HealthNet Community Connection (MCC) and is designed to leverage the insights and experiences of a diverse group of MO HealthNet participants, along with their families and caregivers, to enhance the program.
The MCC serves as a vital platform where these individuals can share their firsthand experiences and provide invaluable recommendations aimed at refining the policies and administration of the program. The council consists of a dedicated group of 15 members, complemented by subject matter experts from MHD and various state departments. The first meeting fostered dynamic discussions and sparked inspiration for future improvements.
The establishment of the council underscores MHD's commitment to incorporating beneficiary feedback into the program’s ongoing development and administration. This collaborative approach is expected to drive meaningful changes that will benefit all participants in the MO HealthNet program.
New Hospice Rates
CMS released new federal hospice rates for federal fiscal year (FY) 2026, effective for dates of service (DOS) October 1, 2025-September 30, 2026.
The Medicaid hospice payment rates are calculated based on the annual hospice rates established under Medicare. These rates are authorized by section 1814(i)(1)(C)(ii) of the Social Security Act, which also provides for an annual increase in payment rates for hospice care services. Rates for hospice physician services are not increased under this provision.
A provider bulletin will be published listing the rates for each hospice level of care by county.
Subscribe to MO HealthNet News to ensure you receive this information.
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Power of Partnership: Bringing Nutrition Education to Families
University of Missouri (MU) Extension, in collaboration with Women, Infants, & Children (WIC) and the three Managed Care (MC) health plans, will be offering a Nutrition Education Program designed to make healthy eating more accessible for participants and families over the next two years. This program offers a series of six online, interactive cooking and nutrition classes. The program focuses on menu planning and cooking using WIC package foods and aims to reduce disparities in access to nutrition education for pregnant participants and families, while eliminating common barriers like transportation and childcare.
What Participants Can Expect:
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Weekly Groceries Provided: Participants will receive a bag of groceries before each class with all the ingredients needed to follow along at home and prepare that week’s recipe.
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Hands-On Cooking Instruction: Each class includes an online, live cooking demo featuring easy, quick, and healthy meals.
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Topics That Matter: Lessons cover healthy eating habits, increasing fruit and vegetable intake, food budgeting, and positive mealtime routines for families.
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Flexible Access: Classes are available online, with the class series offered on different days and at different times for maximum convenience.
Participants who qualify for the program must be pregnant and meet the following criteria:
- Be fewer than 20 weeks pregnant
- Identify as being food insecure (Note: providers identify women as food insecure when submitting information in the Notification of Pregnancy (NOP) screening portal; refer to NOP and Risk Screening for more information.)
- Live in an eligible ZIP code or county where home grocery delivery is possible.
No Cost. Big Impact.
Participants can access free classes and groceries, with incentives like cooking tools for completing 80% of the program. This initiative aims to empower families with skills to prepare healthy meals, improve health outcomes, and increase WIC participation, focusing on reducing poor perinatal outcomes.
If you have patients who meet the criteria and are interested in joining the program, please share the contact information for their MC plan.
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Program of All-Inclusive Care for the Elderly (PACE) Successes
We are proud to share some inspiring success stories from the program. These stories show firsthand how the comprehensive, interdisciplinary model is keeping older Missourians thriving in their homes.
One PACE organization, Jordan Valley Senior Care, shared the following stories:
Participant A: Initially given weeks to months to live due to liver disease and on the transplant list, she has shown remarkable improvement through chronic disease management and is now off the transplant list due to excellent lab results
Participant B: Previously in a skilled nursing facility and advised to enter hospice, she received resources before enrollment, allowing her to return home. Now in full remission from cancer and with 86% of her chronic wounds healed, she expresses immense gratitude for her transformed life.
Another organization, PACE KC, was recently featured on its local Public Broadcasting Service (PBS) affiliate; view the profile piece.
Thank you to the PACE organizations, and their contracted providers, for their continued partnership.
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The Department of Social Services (DSS) and the Department of Health and Senior Services (DHSS) have collaborated to create the resource, Nursing Home Reimbursement: Beginning to End.
This resource walks a provider through the process of nursing home reimbursement from the very beginning of an individual applying for coverage, through the Preadmission Screening and Resident Review (PASRR) process, to billing and receiving payment for services. The resource includes step-by-step instructions for each process, definitions, contact information, and more.
Visit MHD's Nursing Home Provider webpage for additional information.
Optimizing Managed Care Benefits for Maternal and Infant Health Meetings
Nearly 300 providers and community partners registered for the in-person Optimizing Benefits for Maternal and Infant Health Meetings across Missouri. Due to high demand, additional meetings have been scheduled. All MHD providers and community partners are invited to learn about valuable benefits for pregnant women and families, such as case management, doula coverage, and non-emergency medical transportation. Presenters include MHD, Managed Care health plans, Show-Me ECHO, and the Office of Oral Health.
Future meetings:
- October 22, 2025 – Joplin
- November 4, 2025 – St. Louis
- December 8, 2025 – Sedalia
Review the Optimizing Benefits for Maternal and Infant Health flyer for more information. Click the button below to register. Seats are limited. For questions, contact MHD.Education@dss.mo.gov.
 MHD had a great turnout for the Optimizing Benefits meeting in Cape Girardeau, Missouri.
MHD Provider Webinars
The provider trainings for October 2025–December 2025 have been posted online. These program-specific live webinars can also be found on the Provider Training Calendar located on the Education and Training webpage. We also offer a live webinar covering Eligibility and Spend Down on December 11. Register soon. It fills up fast!
Billing for Managed Care
MHD has added the training sessions offered by the Managed Care health plans to the Provider Training Calendar so providers can find resources to bill for all MHD participants in one place.
For a recap of the information covered during our live webinars, review the MO HealthNet Provider Overview Guide. For additional resources refer to Education and Training. Email MHD.Education@dss.mo.gov for any questions.
MO HealthNet Doula Enrollment
Doulas may access the Provider Enrollment Guide for assistance with enrolling as a MO HealthNet doula provider and taking MO HealthNet participants as clients.
The information included in The Guide for Doulas contains step-by-step instructions, a flowchart detailing the process, and contact information for any questions.
For additional assistance, email MHD.Education@dss.mo.gov.
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Office Hours for the Notification of Pregnancy (NOP) Process
MHD will host two one-hour sessions highlighting the current NOP billing process and allow providers and screeners to ask questions.
If you have questions, email them to MHD.NOP@dss.mo.gov.
The sessions will run from 11:00 a.m.–12:00 p.m. and will be offered on October 7 and 8. Use the buttons below to register.
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Participants' applications and renewals for MO HealthNet are handled by the Family Support Division (FSD). Here are some metrics around their current processing times.
Call Center wait times
- Over the past two weeks wait times for FSD queues have been at or below 10 minutes.
Application Processing
- Over the summer FSD caught up over 7,600 backlogged applications
- Since August 1, 2025 there’s been a big effort to bring processing times for applications down.
- FSD is processing most applications within 30 days of receipt
Provider Portal requests
- FSD has worked down from being backlogged by over 10,000 tasks in provider portal to now working tasks in the same month they receive them
- FSD is processing urgent medical requests within 48 hours; most being processed within a few hours of receiving them
- FSD is processing newborn, add a pregnancy, and other inquiries within 22 days
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Enrollment
MMAC was involved in over 102,000 transactions related to provider enrollment. These included:
- 13,014 new providers enrolled
- 7,171 revalidations processed
- 4,693 applications rejected
- 17,732 updates processed
- 60,102 email inquiries
As of September 1, 2025, there are 82,854 active Medicaid providers
- MMAC has seen a 25% increase in providers since Fiscal year (FY) 2018
- MMAC saw a 9% growth in providers from FY 2024 to FY 2025
 Recoveries/Cost Savings:
For FY 25, MMAC reported the following:
- $17.4M in recoveries
- $50.7M cost avoidance
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Notification of Pregnancy Billing and Payment
Prenatal Screenings: The following codes are reimbursed at $50.00 for completion and entry into the state’s new NOP and Risk Screening Portal.
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Code
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Description
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Notes
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G9919-TH
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Positive comprehensive risk screening and provision of recommendations/referrals (Screening only positive if there is a DX code associated with the non-clinical risk factor indicated)
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At least one non-clinical risk factor Z-code should be included when billing G9919-TH
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G9920-TH
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Negative comprehensive risk screening (No non-clinical risk factor DX code reported)
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No risk factor Z-codes should be submitted when billing G9920-TH
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Prenatal screenings require a Gestational Age DX code.
- Gestational weeks 1-7 should always be reported as Z3A01. For example, if ‘2’ is entered in this field on the Portal, Z3A01 should be coded on the claim.
- Weeks 8+ should be reported as Z3Axx, where xx is the estimated weeks gestational age. For example, if ’18’ is entered in this field on the Portal, then Z3A18 should be coded on the claim.
Postpartum Screenings require a DX code Z39.2.
- Postpartum Screenings are billable and reimbursed $50.00.
- Providers should document the findings from the Postpartum Screening in the patient’s record, but findings should not be entered in the NOP and Risk Screening Portal.
For any questions, contact MHD.NOP@dss.mo.gov.
Preferred Agents
Ozempic®, Trulicity®, and Victoza® are preferred agents in the Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists & Combination Agents Indicated for Diabetes PDL Edit
- All three (3) preferred agents are available with no prior authorization or diagnosis required.
Zepbound® is the preferred agent in the Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Indicated for Obesity PDL Edit
- Submission of a relevant, billable ICD-10 code for obesity on the pharmacy point of sale transaction may allow transparent approval without the need for prior authorization.
- Otherwise, a prior authorization for clinical criteria will be required.
- Participants currently utilizing Mounjaro® (tirzepatide) will be required to utilize Zepbound (tirzepatide). Zepbound is available in the same dosage strengths and dose forms as Mounjaro. Participants with recent compliance to Mounjaro will be automatically approved for Zepbound.
Additional tips:
- MO HealthNet will only cover one GLP-1 claim per month.
- Under current laws and regulations, pharmacists in Missouri are not authorized to make medical diagnoses for this class of medication, as doing so falls outside their scope of practice. If pharmacy staff are suspected of circumventing MO HealthNet policy by altering diagnosis codes provided by the prescriber, such claims may be subject to audit and could lead to administrative action, including, but not limited to, claim recoupment.
Stay Informed with eMOMED: Your Essential Resource for MO HealthNet Providers
For MO HealthNet providers, staying informed is vital. Regular visits to the MO HealthNet Web Portal, eMOMED.com, are highly recommended. It offers essential updates and tools, including:
- Alerts for maintenance outages
- MO HealthNet Contact Information for support
- Frequently Asked Questions for common issues
- System Maintenance Schedule for planned downtimes
- Links to Claims Processing Schedule, Electronic Billing Documents, and Provider Enrollment Information
- Provider Education & Training Calendar for professional development
In summary, eMOMED is a valuable resource for MO HealthNet providers to stay informed and equipped
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Ensuring Eligibility: A Key Step for MO HealthNet Providers
Verifying eligibility is a vital step for MHD providers to prevent any disruptions in coverage or services for participants. It's important to note that having a prior authorization for services does not automatically mean that a participant is eligible for those services. Therefore, providers must confirm eligibility on the actual date of service to ensure participants continue to qualify for the necessary care. Since eligibility information is updated daily, this verification needs to occur before each appointment.
Providers can easily check eligibility through eMOMED by accessing the participant eligibility section under “Welcome to eProvider” on the eMOMED homepage. Alternatively, eligibility can be verified through the Provider Communications Interactive Voice Response (IVR) system by dialing either (573) 751-2896 or toll-free at (833) 222-7916 and selecting option 1.
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Enhancing Trust Through Effective Data Governance and Privacy at MHD
At MHD, we prioritize data governance and privacy to ensure the accuracy and security of participant and provider information. We maintain organized and reliable data, crucial for providers relying on trustworthy information. Our commitment to data privacy involves adhering to HIPAA and other regulations, ensuring personal details are shared securely and appropriately. This dual focus enhances operational efficiency for healthcare providers and reinforces participant trust. MHD is dedicated to protecting data integrity and privacy in health information management.
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New! Now Covered in the Durable Medical Equipment (DME) Program
On September 1, 2025, MHD implemented coverage of Healthcare Common Procedure Coding System (HCPCS) codes L3807 and L3809 in the DME Program.
L3807 is a code for a prefabricated, static wrist hand finger orthosis (WHFO) brace that supports and/or immobilizes the wrist, hand, and fingers but does not include joints. The item can be trimmed, bent, or molded by a qualified professional to fit a specific patient's needs, often for conditions like arthritis or post-injury recovery.
L3809 is a code for a prefabricated, off-the-shelf WHFO that provides rigid stabilization and does not have any joints. This type of brace offers immediate support for various conditions such as post-surgical recovery, fractures, sprains, nerve injuries, and is used in orthopedic rehabilitation.
For additional information, please reference Provider Bulletin 48-07.
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The Depression Screening and Follow-Up codes of G8431 and G8510 will become effective October 1, 2025, for participants in a Managed Care Plan. These codes became effective January 1, 2025, for Fee-For-Service participants.
MHD will limit screening to one unit per calendar year. However, adding the TH modifier for pregnant and postpartum participants will increase the limit to four screenings per year.
Additional information can be found in Provider Bulletin 47-36 or Section 2.11 of the Physician Provider Manual.
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Behavioral Health Assessment for Children Under Age 6
Effective October 1, 2025, MHD will increase the unit limits for behavioral health assessment (procedure codes 90791 and 90792) for children under age 6 to facilitate more developmentally appropriate assessments.
Providers may deliver up to five units of these procedures per six-month period, although the maximum daily quantity remains one unit.
Additional information can be found in Provider Bulletin 48-08.
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MHD is preparing to implement claims validation for Electronic Visit Verification (EVV) with a soft launch in January 2026. During this phase, all EVV-required claims must have a matching visit in the EAS, and providers will receive remark codes on their remittance advice about future payment policy changes. Claims without matching visits will still be paid, allowing providers to familiarize themselves with these codes.
After the soft launch, a hard edit will deny claims that do not match EVV visit information, starting with personal care service providers. Home Health Care Service providers and those under the Department of Mental Health will follow. Providers must continue submitting claims but must ensure that visit data is accurate in the EAS.
More updates will be shared in Provider Bulletins and Hot Tips, and detailed information is available on the EVV Provider webpage.
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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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