Important Update for Missouri Ordering, Prescribing and Referring Providers

If you are an ordering, prescribing or referring provider in Missouri, you must enroll with Medicaid even if you do not accept Medicaid. This is required under state and federal regulations.

To conform to these requirements, MO HealthNet is changing its claims processing system. Soon the system will deny all claims that require an order, prescription or referral from a doctor or other licensed health care professional unless that provider has an active enrollment record on file.

If you are not an actively enrolled provider, you will begin to see an alert when receiving remittances for durable medical equipment, imaging medical claims, independent laboratory medical claims and home health claims. The alert will notify you that the remittance has been paid, but the ordering provider for this bill must update their enrollment record.

If you receive this alert in a remittance, first verify that the ordering provider information that you submitted on the claim is correct. If it is, you should contact the ordering provider and request that they update their enrollment record.

Claims Will Be Denied Beginning November, 2017 Without MO HealthNet Enrollment

For now, claims will continue to be paid even if the ordering, prescribing or referring provider is not enrolled with Medicaid. However, that will not be the case later this year.

Beginning in November, 2017, claims will be denied if the ordering, prescribing or referring provider information is missing or if not enrolled with MO HealthNet. 

For more help with the enrollment process and to download an application or a fillable PDF form, visit the Missouri Department of Social Services Medicaid Audit and Compliance Unit (MMAC) website. Questions can be addressed to MMAC.ProviderEnrollment@dss.mo.gov.

Although MMAC has committed to expediting all applications received, don’t delay in submitting your paperwork to avoid denied claims and remittances.

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.