2018 MO HealthNet Provider Hot Tips

The MO HealthNet Division provides hot tips to providers to assist them in receiving timely reimbursement for services provided. Please share these hot tips with your billing staff.

Fluoride Varnish During Well Child Check

April 16, 2018

Fluoride varnish is a covered service for participants age five and under, when the need is identified through an Early Periodic Screening, Diagnostic, and Treatment (EPSDT) visit. Fluoride varnish may be applied by physicians and nurse practitioners along with other medical professionals (RN, LPN, Physician Assistant) working in a physician’s office or clinic.Fluoride treatment is limited to 1 application of stannous fluoride, acid-phosphate fluoride or fluoride varnish per participant, 2 times per rolling year, per provider.

Training in the application of fluoride varnish is required in order for providers to bill MO HealthNet. Documentation to support their completed training must be retained by the medical office. This completed training documentation must be made available upon request by the MO HealthNet Division. Training is available on-line through the Department of Health and Senior Services, Division of Community and Public Health at http://health.mo.gov/blogs/psp/information-for-medical-professionals/.

Application of fluoride varnish should be billed on the CMS-1500 claim form or the appropriate electronic claim form. To bill MO HealthNet for fluoride varnish, enter the procedure code D1206 in Field 24.D on the CMS-1500 or the appropriate field on an electronic claim form.

Outpatient Hospital Billing Tips for 340B Providers

April 3, 2018

The submission of a National Drug Code (NDC) is not required for 340B providers on outpatient hospital claims; however, MO HealthNet prefers claims be submitted with a valid Healthcare Common Procedure Coding System (HCPCS) procedure code and a valid NDC. A valid NDC and/or a valid HCPCS procedure code (not a dump code) must be billed for each medication for MO HealthNet to identify drugs dispensed. For drugs without a valid HCPCS procedure code, revenue code 0250 "General Classification: Pharmacy” should be used with the appropriate NDC. A critical component to submitting claims with an NDC is to ensure that the appropriate HCPCS procedure code is billed with each NDC. To ensure accurate billing of drug charges, MHD will use the Noridian Crosswalk https://www.dmepdac.com/ to determine whether the appropriate HCPCS procedure code is billed for the submitted NDC. If the NDC submitted is not valid for the HCPCS procedure code submitted claims will deny.

Pharmacy Services for Participants with Presumptive Eligibility

February 26, 2018

The MO HealthNet Presumptive Eligibility Authorization (PE-3) form and the Show Me Healthy Babies Presumptive Eligibility (SMHB-PE) Authorization form serve as proof of presumptive eligibility. Pharmacy providers should check the dates of eligibility on the authorization form to determine if the presumptive eligibility period is active. Pharmacy providers should make a photocopy of the form and maintain the copy in the pharmacy files for documentation of eligibility.

MO HealthNet will reimburse any medication dispensed within the eligibility period shown on the form. Pharmacies may contact Pharmacy Administration at (573) 751-6963 if they have questions. For more information, please refer to Provider Bulletin on Presumptive Eligibility Authorization Notices.

Social Security Number Removal Initiative

January 11, 2018

The Medicare Access and CHIP Reauthorization Act (MACRA) requires CMS to remove Social Security Numbers (SSNs) from Medicare beneficiary ID cards and issue  new cards with  Medicare Beneficiary Identification (MBI) numbers.

CMS will start mailing the new Medicare Beneficiary ID cards with the new MBI numbers to participants beginning in April 2018. They are allowing an 18-month transition period that ends December 31, 2019. During the transition period, physicians and other providers may submit a Medicare claim using either the participant's valid and active Health Insurance Claim Number (HICN) or the new MBI number.

All Medicare claims submitted after January 1, 2020, will be required to use the new MBI number. Claims filed with the participant's old HICN will be rejected, at that point.

MO HealthNet will also have a transition period from April 1, 2018 through December 31, 2019, in which we are able to accept either the old HICN or the new MBI number. Effective January 1, 2020, providers will only be able to submit claims using the new MBI number.