Providers must be enrolled in the MO HealthNet program to provide medical services. Those who participate in the MO HealthNet Program agree to accept MO HealthNet payment as reimbursement in full for any services provided to MO HealthNet participants. A participant cannot be billed for the difference between the MO HealthNet payment and the provider’s billed charges. MO HealthNet Managed Care services are provided in accordance with the terms and conditions of the contract between MHD and the MO HealthNet Managed Care health plans. Participants enrolled in MO HealthNet Managed Care access services through the health plan’s provider network. The health plan network may include providers not enrolled in the fee-for-service program.
Policies & Procedures
- Apply for EMOMED
- RA remark codes and claim adjustment reason codes
- Radiology Benefit Management Information
- Implementation of 5010 and D.0
- Exempt Diagnosis Table updated 10/12/16
- Claims Processing and Payment Schedule
- HIPAA - EDI Companion Guide
- HIPAA related Code Lists
- MO HealthNet Guide — Puzzled by the Terminology? updated 03/01/16
This printable guide explains the various MO HealthNet terms and codes.
- Benefit Matrix shows the various benefits for each of the MO HealthNet programs, and if they also have cost sharing or any co-pays.
- Training Information
Fee Schedules & Rate Lists
- Fee Schedules
- Independent Rural Health Clinic Medicare/Medicaid Interim Rate List
- Nursing Facility Rate List
- Outpatient Hospital Radiology Fee Schedule, updated 03/20/17