If you provide services to people with disabilities, seniors, blind & visually impaired, or women with breast or cervical cancer who get their health care services through MO HealthNet, you can provide services through the Fee-For-Service Program. Providers must be enrolled in the MO HealthNet program to provide medical services through the Fee-For-Service Program.
If you participate in the MO HealthNet program, you 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, sometimes called "budget or balance billing."
Policies & Procedures
- Provider Bulletins
- Provider Hot Tips
- Provider Manuals
- Provider Manual by Section Provides a resource list of General and Program Sections of the Provider Manual
- Apply for EMOMED
- GEMT Uncompensated Cost Reimbursement Program, updated 10/21/19
- Claims processing and payment schedule
- Diagnosis Codes Exempt from Inpatient Certification, updated 11/22/22
- HIPAA - EDI companion guide
- Radiology benefit management information
- Remittance Advice Remark Codes and Claim Adjustment Reason Codes
- School District Administrative Claiming (SDAC)
- MO HealthNet forms
- EBPT Invoice Form
- Provider Update Request
- HCBS Ownership & Structure Change Request
Fee Schedules & Rate Lists
- Fee Schedules
- IRHC Medicare/Medicaid Interim Rate list
- Nursing Facility Rate list
- Outpatient Hospital Radiology Fee Schedules:
- Outpatient Hospital Surgical Procedural Fee Schedules:
- Effective 01/01/19 (updated 11/30/18)
- Outpatient Hospital Lab Fee Schedules:
- Effective 01/01/21 (updated 04/08/21)
- Outpatient Hospital Simplified Fee Schedules:
Education and Training
- Education and Training Resources Offers provider webinar schedules and general and program specific educational resources.
- Contact Education and Training Provides the Education Specialist assigned to each program and how to request training.
- Provider Resource Guide Provides descriptions of medical eligibility (ME) codes, shows limited and comprehensive benefits and provides MO HealthNet contact information.
- Benefit Tables (formerly Benefit Matrix) This shows the various benefits for each MO HealthNet programs, and if they have cost sharing or co-pays.
- Civil rights compliance information
- Enrollment guide information and requirements for new applicants and existing providers
- Missouri Medicaid Audit & Compliance (MMAC)
- Provider enrollment application