Review the Provider Information page and Frequently Asked Questions for information on the MO HealthNet Division (MHD).
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| Program | Role | Contact Information |
|---|---|---|
| Behavioral Health Services | Assists with questions related to MO HealthNet Behavioral Health services. | MHD.BehavioralHealth@dss.mo.gov |
| Clinical Services | Responsible for clinical policy development for MHD. Review MO HealthNet Provider Manuals. | MHD.ClinicalServices@dss.mo.gov |
Cost Recovery/ Third Party Liability | Contact to report injuries sustained by MO HealthNet participants, for questions about the estate of a deceased participant, for problems obtaining a response from an insurance carrier, unusual situations concerning third party insurance coverage for MO HealthNet participants, and questions regarding the Health Insurance Premium Payment Program (HIPP). | (573) 751-2005 |
| Education & Training | Instructs providers on navigating MHD provider resources, proper billing methods and procedures for claim filing via eMOMED. | (573) 751-6683 |
| Electronic Visit Verification | System required for all Personal Care and Home Health Care services to document the delivery of these services under MHD. | Ask.EVV@dss.mo.gov |
| Exceptions | Review Durable Medical Equipment (DME) or physical therapy requests not normally covered for MO HealthNet participants over the age of 21. | Fax Requests: (573) 522-3061 (800) 392-8030 |
| Institutional Reimbursement Unit (IRU) | FQHC/IRHC reimbursements, responsible for the administration of state regulations, state plan amendments, and inquiries regarding reimbursement for these programs. | (573) 751-5663 |
Managed Care Health Plans | Healthy Blue | (833) 388-1407 |
Managed Care Health Plans | Home State Health | ManagedCareContracting@centene.com (855) 694-HOME (4663) |
Managed Care Health Plans | Show Me Healthy Kids | ManagedCareContracting@centene.com (877) 236-1020 |
Managed Care Health Plans | United HealthCare | (866) 292-0359 |
Managed Care Liaisons | Assists providers unable to resolve a Managed Care issue directly with the health plan. Complete a Managed Care Provider Resolution Support Request | MHD.MCCommunications@dss.mo.gov |
| Overpayments | Contact to address repayment of overpayment amounts because of an audit or investigation. | MMAC.Financial@dss.mo.gov |
| Participant Services | Assists participants with provider issues and questions regarding services, coverage, and unpaid bills. Managed Care participants should contact their health plan. | (800) 392-2161 |
| Pharmacy Administration | The Pharmacy Program manages reimbursement for outpatient, fee-for-service prescription drugs, over-the-counter products, and devices. Program and policy development are guided by best practices and evidence-based medicine. | (573) 751-6963, Monday through Friday, 8:00 a.m. to 4:30 p.m. |
Pharmacy Pre- Certification Help Desk | Drug Prior Authorizations (PAs) | (800) 392-8030 option 3 Fax Drug PA Requests: (573) 636-6470 |
Medical Pre- Certification Help Desk | Medical Pre-Certifications and Drug PAs | (800) 392-8030 or CyberAccess |
Pre- Certification Help Desk | To become a CyberAccess User contact the Conduent Help Desk | CyberAccessHelpDesk@conduent.com (573) 632-9797 or (888) 581-9797 |
| Program of All Inclusive Care for the Elderly | PACE provides comprehensive health care, social, recreational, and wellness services to allow older adults to live safely in their homes. | MHD.PACE@dss.mo.gov |
Provider Communications | Available to assist providers with questions about proper claim filing, claims resolution or disposition, participant eligibility, and verification. | (833) 222-7916 (573) 751-2896 Via eMOMED |
| Provider Enrollment | Missouri Medicaid Audit & Compliance (MMAC) is responsible for enrolling MO HealthNet providers. Visit the Provider Enrollment Guide for detailed information on MO HealthNet enrollment. Refer to the Managed Care Provider Toolkit for information on enrolling with the health plans. | MMAC.ProviderEnrollment@dss.mo.gov (833) 818-1183 |
| Provider Technical Help Desk | Provides technical assistance in establishing the required electronic claims and remittance advice formats, network communication, HIPAA training partner agreements, and eMOMED claim filing service. | (573) 635-3559 |
| Reporting Fraud | MMAC investigates allegations of fraud, waste, and abuse. | (573) 751-3285 |
| Spend Down Unit | Providers may submit incurred medical expenses on behalf of the participant online using the MO HealthNet Spend Down Provider form. Participants may provide proof of qualifying expenses and identify which months the expenses should be applied to using the online MO HealthNet Spend Down Participant form. | (855) 600-4412 |