MO HealthNet’s Medicare Part D Emergency Override Authorization Plan is designed to provide assistance with prescription drug coverage to individuals who have been unable to receive prescription drug assistance through Medicare Part D.

The program must be accessed by a provider, and the provider must provide information about the attempts made to access prescription drug assistance through Medicare Part D, including contacting Medicare and/or the individual’s Prescription Drug Plan.

The individual seeking assistance through their provider must be eligible for BOTH MO HealthNet and Medicare.

Eligibility for the Medicare Part D Emergency Override Authorization Plan:

  • Full benefit dual eligible individuals who present MO HealthNet and Medicare cards, or have a recent previous history of MO HealthNet drug billing.
  • Does NOT apply to dual eligibles who receive MO HealthNet medical benefits but were not eligible for drug benefits.
  • Does NOT apply to former Missouri Senior Rx members who are now on the Missouri Rx Plan (MORx).

Steps to follow BEFORE submitting the Medicare Part D Emergency Override Authorization Plan Claim Form:

  • Confirm proof of full dual eligible status.
  • Bill MO HealthNet to verify claim denial.
  • Submit an E1 query to the TrOOP facilitator to check eligibility for Medicare Parts A and/or B OR Part D plan (Plan) enrollment.
    • If the E1 query returns Part D plan enrollment information, bill the appropriate Plan - do not continue this process.
    • If the E1 query returns Part D plan enrollment information, the appropriate Plan is billed, but the claim is denied for Patient Not Eligible, refer the participant to their Plan’s toll free number .
    • If the E1 query returns Part D plan enrollment information, the appropriate Plan is billed, but the claim returns a copay higher than the $5 dual eligible limit, refer the participant to their Plan’s toll free number (see link below).
    • If you are unable to identify the appropriate Plan to bill, but able to verify full dual eligibility, continue this process.
  • The participant may have proof of auto-enrollment into a Plan from Medicare (CMS), possibly a yellow auto assignment notice sent by CMS listing the plan to which they were assigned.
    • If the E1 doesn't return the claim processing information for that Plan, call the Medicare pharmacy line (1-866-835-7595) available Mon-Fri 8 A.M.-8 P.M. EST to verify the participant’s enrollment into that Plan.
    • If Medicare cannot confirm enrollment into a Plan, regardless of written proof, refer the participant to the Plan’s toll free number.
    • If neither the Plan nor Medicare can confirm enrollment, continue this process.

Steps To Complete The Medicare Part D Emergency Override Authorization Plan Claim Form:

  • Collect complete participant information from your files (name, address, telephone, date of birth, MO HealthNet number and Medicare Claim number [HICN] from their Medicare card) — also get contact information for personal representative(s) for this participant. You will need to submit your MO HealthNet provider ID with this form.
  • COMPLETELY fill out the Medicare Part D Emergency Override Authorization Claim Form. Incomplete forms will not be processed.
  • Fax completed form to 573-522-8514.