2020 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.

2020 Provider Tips Index

COVID-19: DME- Signature Requirements

March 30, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

Delivery Slip Signature Requirement

Some items of Durable Medical Equipment are delivered to participants’ homes. The signature of the participant or their designee is currently required on the delivery slip. During this event, MO HealthNet will temporarily waive this requirement, and the DME provider can document to whom the equipment was delivered. If the equipment is delivered to anyone other than the participant, the DME provider should document the name and relationship to the participant. A notification will be sent out reinstating the original requirement at a later date.

Certificate of Medical Necessity Form (CMN) Signature Requirement

Certain Durable Medical Equipment (DME) requires a Certificate of Medical Necessity Form (CMN). The form requires an original provider signature in field 14. Due to the COVID-19 outbreak MO HealthNet will also temporarily waive the original signature requirement. We will accept a typed signature in field 14. It does not have to be an original signature or e-signature. A notification will be sent out reinstating the original requirement at a later date.

Please contact Provider Communications at 573-751-2896 if you have additional questions. You may also send inquiries to Provider Communication via eMOMED. -19 questions can be sent to mhd.covid-19@dss.mo.gov

Refer to the DME Provider Manual section 13.15.B for details on the Direct Delivery Requirements and section 7.2 for details on the CMN process.

COVID-19: Sedative Hypnotic Preferred Drug List

March 27, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

During this event, the MHD will maintain the current clinical criteria for the Sedative Hypnotic Preferred Drug List. The MHD had previously planned to implement significant utilization management changes to the Sedative Hypnotic Preferred Drug List. However, in order to minimize provider burden and disruption to patient care during the COVID 19 pandemic, the MHD will delay implementation of the new criteria until July 2020.

A copy of the current criteria, and future criteria, is available on the MO HealthNet Pharmacy Clinical Edits and Preferred Drug Lists website, located at: https://dss.mo.gov/mhd/cs/pharmacy/pages/clinedit.htm.

Missouri receives approval from the Centers of Medicare & Medicaid Services of 1135 waiver request related to COVID-19

March 26, 2020

On March 13, 2020, the President of the United States issued a proclamation that the COVID-19 outbreak in the United States constitutes a national emergency. On the same day, the Secretary of the United States Department of Health and Human Services invoked his authority to waive or modify certain requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). This waiver also ensures that health care providers that furnish such items and services in good faith may be reimbursed for those items and services.

This authority took effect at 6PM Eastern Standard Time on March 15, 2020, with a retroactive effective date of March 1, 2020. The emergency period will terminate, and section 1135 waivers will no longer be available, upon termination of the public health emergency, including any extensions.

Missouri submitted their request for flexibility or waiver of several requirements on March 20, 2020 and received approval from CMS on March 25, 2020. https://dss.mo.gov/covid-19/pdf/cms-approval-letter-for-waiver-1135.pdf

The areas of flexibility or waiver requested focused on strengthening the healthcare workforce, flexibility in some Emergency Medical Treatment and Labor Act (EMTALA) regulations, removing barriers to the delivery of health care services, removing restrictions to payment limitations to providers, and, removing restrictions to provider enrollment and revalidation efforts. Additionally, flexibility in waiving certain prior authorization requirements, waiver of timely filing requirements, flexibilities related to appeals and State Fair Hearings, waiver of public notice requirements, waiver of implementation of some performance deadlines, and flexibility with critical access and alternative setting requirements were requested.

Missouri anticipates further approvals by CMS under this and other authorities in the coming days.

COVID-19: Telehealth – REVISED March 26, 2020

March 23, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

MO HealthNet covers Telehealth services. MO HealthNet allows any licensed health care provider, enrolled as a MO HealthNet provider, to provide telehealth services if the services are within the scope of practice for which the health care provider is licensed. The services must be provided with the same standard of care as services provided in person.

Telehealth services may be provided to a MHD participant, while at home, using their telephone. The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.

There is not a separate telehealth fee schedule. Reimbursement to health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided.

Please find information regarding Telehealth billing and reimbursement here: https://dss.mo.gov/mhd/providers/pdf/bulletin41-20-2018.pdf. You can also view the Missouri Telehealth law here: 191.1145, 191.1146, 208.670, and 208.677.

Newly added (03/23/2020): Hospitals may bill a facility fee for distant site services provided in their facilities. The distant site service must be reported on the UB04 claim form with the procedure code, GT modifier, and zero billed charges. The billed charges for the facility fee must be billed on a separate line of the claim. The physician providing the service will still bill for their distant site services on the medical claim form.

RHCs may use either their RHC provider number or their non-RHC provider number when operating as a distant site. Please find information regarding RHC billing for Telehealth here: https://dss.mo.gov/mhd/providers/pdf/bulletin41-44_3-19.pdf.

RHCs, both Provider Based and Independent, billing for distant site services on a UB04 claim form must include the GT modifier on their claim.

During this event, the MHD is:

  • Waiving the requirement that physicians must have an established relationship with the patient before providing services via telehealth.
  • Waiving the co-payment for any services provided by means of Telehealth.
  • **Allowing the use of telephone for telehealth services.
  • **Allowing quarantined providers and/or providers working from alternate sites or facilities to provide and bill for telehealth services. These services should be billed as distant site services using the physician’s and/or clinic provider number.
  • Waiving the requirement that, in order to treat patients in this state with telemedicine or telehealth, health care providers shall be fully licensed to practice in this state. MHD will allow providers to bill for telehealth services as long as they are licensed in the state in which they practice.
    • **Providers must still be enrolled as MHD providers through Missouri Medicaid Audit and Compliance (MMAC).

This Hot Tip applies to providers contracted with the Managed Care Organizations.

**Clarified 3/26/20

COVID-19: Sterilization

March 25, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

MO HealthNet participants who are pregnant women may elect to have a tubal ligation ("elective sterilization") and this is a covered service. During this event, if a participant's elective sterilization procedure is rescheduled, MO HealthNet will ensure coverage of the surgery at the later date.

This Hot Tip also applies to providers that are contracted with the Managed Care Organizations.

COVID-19: Radiology Revised

March 25, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

The MHD’s Radiology Benefit Manager (RBM) is currently auto approving Chest CT Scan HCPCS codes 71250, 71260, and 71270 when the following COVID-19 related diagnosis codes are present: B34.2, B97.29, J20.8, J22, J40, J80, J98.8, Z03.818, and Z20.828. The MHD is also waiving the co-payment for these codes.

The MHD is working to update the claims processing system to waive the prior authorization requirements for these tests when the above diagnosis codes are present. Providers must continue to submit prior authorization requests by using the web tool, Cyber Access, or by calling the MO HealthNet Call Center at (800) 392-8030, option 5, until the system work to waive the prior authorization requirements is complete.

Prior authorizations for ALL procedures managed by the MHD’s RBM will be approved for 90 days during the COVID-19 crisis. The list of procedures the RBM manages can be found here: https://www.healthhelp.com/wp-content/uploads/MOHTN_PROCCODES.pdf

This Hot Tip also applies to providers that are contracted with the Managed Care Organizations.

COVID-19: MO HealthNet providers providing services at additional locations

March 24, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

MHD and Missouri Medicaid Audit and Compliance (MMAC) do not require performing providers to receive approval to provide MHD covered services to MHD enrolled participants in different facilities or at different sites. MHD will reimburse providers for services provided at different facilities and different site. Providers should continue to bill the way they currently bill.

This Hot Tip also applies to providers who are contracted with the Managed Care Organizations.

COVID-19: Multi-Function Ventilator, March 23, 2020

March 23, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. This virus has been named “SARS-Cov-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).

During this event, MHD will allow temporary coverage and reimbursement for a multi-function ventilator, HCPCS code E0467 with a restriction specifically for the ventilator. For participants ages 20 and under, this will be administered through the Healthy Children and Youth (HCY) program using HCPCS code E1399EPRR. For participants 21 and older, the request must be made through Exceptions process using HCPCS code E0467UBRR. Reimbursement is $1001.46 per month.

COVID-19 - Teledentistry

March 23, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

MO HealthNet covers Teledentistry services. MO HealthNet allows any licensed dental provider, enrolled as a MO HealthNet provider, to provide Teledentistry services if the services are within the scope of practice for which the dental provider is licensed. The services must be provided with the same standard of care as services provided in person.

Teledentistry services may be provided to a MHD participant, while at home, using their telephone. The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.

The CDT codes approved for Teledentistry are:

  • D9995 Teledentistry – synchronous; real time encounter. Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service; and
  • D9996 Teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review. (Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.)

Both codes are reimbursed at a rate of $14.82.

During this event, the MHD is:

  • Waiving the requirement that providers must have an established relationship with the patient before providing services via Teledentistry.
  • Waiving the co-payment for any services provided by means of Teledentistry.
  • Allowing quarantined providers to provide Teledentistry services from their homes. These services should be billed as distant site services using the clinic’s provider number.
  • Waiving the requirement that, in order to treat patients in this state through the use of Teledentistry, providers shall be fully licensed to practice in this state. MHD will allow providers to bill for Teledentistry services as long as they are licensed in the state in which they practice.

This Hot Tip also applies to providers that are contracted with the Managed Care Organizations.

MHD has established an e-mail account for providers with questions about special accommodations and billing questions during the COVID-19 event. Please contact us at mhd.covid-19@dss.mo.gov.

COVID-19 - Additional albuterol inhalers as preferred products

March 20, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

During this event, MHD is adding two additional albuterol inhalers as preferred products. The list of preferred beta adrenergic short acting inhalers is:

  • ProAirâ HFA
  • Proventilâ HFA
  • Ventolinâ HFA
  • Xopenex HFAâ

MHD is currently completing system work for these to process without a call to the helpdesk, which should be completed by the end of the day on March 20, 2020.

COVID-19: Registered Behavior Technician

March 20, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

The MHD recognizes that testing centers that administer the test required for the Registered Behavior Technician® credential are closed as of March 16, 2020 due to COVID-19.

During this event, MHD will waive the RBT requirement for technicians who meet all other requirements but have not yet taken the RBT exam. Technicians must work under the supervision of a licensed behavior analyst and the supervisory relationship must be documented in writing.

MHD has established an e-mail account for providers with questions about special accommodations and billing questions during the COVID-19 event. Please contact us at mhd.covid-19@dss.mo.gov

COVID-19: Pharmacy Signature Log Requirement

March 20, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

For Pharmacy claims, MO HealthNet requires documentation of “offer to counsel” and also requires maintenance of a signature log to prove the prescription was delivered and received.  This requirement is in section 13.11.B of the MO HealthNet Pharmacy Provider Manual.

During this event, the MHD will allow pharmacies to document in the signature log that the participant was not required to sign, in order to practice social distancing due to COVID-19.

COVID-19: E-Prescribing

March 19, 2020

MO HealthNet has received several questions regarding telephoning a prescription for controlled substances due to the COVID19 Pandemic.

E-Prescribing is allowed for all schedules if in compliance with BNDD/DEA requirements.

The requirements of a telephoned controlled substance prescription are BNDD/DEA requirements and are not under the authority of MO HealthNet. For your reference, the requirements are below for a CII prescription to be called in to a pharmacy:

§1306.11 Requirement of prescription.

(d) In the case of an emergency situation, as defined by the Secretary in §290.10 of this title, a pharmacist may dispense a controlled substance listed in Schedule II upon receiving oral authorization of a prescribing individual practitioner, provided that:

(1) The quantity prescribed and dispensed is limited to the amount adequate to treat the patient during the emergency period (dispensing beyond the emergency period must be pursuant to a paper or electronic prescription signed by the prescribing individual practitioner);

(2) The prescription shall be immediately reduced to writing by the pharmacist and shall contain all information required in §1306.05, except for the signature of the prescribing individual practitioner;

(3) If the prescribing individual practitioner is not known to the pharmacist, he must make a reasonable effort to determine that the oral authorization came from a registered individual practitioner, which may include a callback to the prescribing individual practitioner using his phone number as listed in the telephone directory and/or other good faith efforts to insure his identity; and

(4) Within 7 days after authorizing an emergency oral prescription, the prescribing individual practitioner shall cause a written prescription for the emergency quantity prescribed to be delivered to the dispensing pharmacist. In addition to conforming to the requirements of §1306.05, the prescription shall have written on its face “Authorization for Emergency Dispensing,” and the date of the oral order. The paper prescription may be delivered to the pharmacist in person or by mail, but if delivered by mail it must be postmarked within the 7-day period. Upon receipt, the dispensing pharmacist must attach this paper prescription to the oral emergency prescription that had earlier been reduced to writing. For electronic prescriptions, the pharmacist must annotate the record of the electronic prescription with the original authorization and date of the oral order. The pharmacist must notify the nearest office of the Administration if the prescribing individual practitioner fails to deliver a written prescription to him; failure of the pharmacist to do so shall void the authority conferred by this paragraph to dispense without a written prescription of a prescribing individual practitioner.

(5) Central fill pharmacies shall not be authorized under this paragraph to prepare prescriptions for a controlled substance listed in Schedule II upon receiving an oral authorization from a retail pharmacist or an individual practitioner.

For further guidance, please contact BNDD at bndd@health.mo.gov or DEA at ODLP@usdoj.gov.

COVID-19: New email address for Providers

March 18, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

An email address has been set up for provider questions related to billing for COVID-19 testing, treatment, services provided via telehealth, etc.

MO HealthNet will respond to these questions and track the inquiries to compile FAQ’s that will be posted on the Education/Training webpage.

Email: MHD.COVID-19@dss.mo.gov

Expedited Enrollment Processing

March 18, 2020

To expedite provider enrollment into the MO HealthNet program (Missouri's Medicaid program), Missouri Medicaid Audit & Compliance (MMAC) is providing same day or overnight approvals of most new provider enrollment applications for physicians, advanced practice nurses, and other licensed practitioners. Visit https://mmac.mo.gov/providers/ for more information.

COVID-19: Radiology

March 17, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

The MHD’s Radiology Benefit Manager is currently auto approving Chest CT Scan HCPCS codes 71250, 71260, and 71270 when the following COVID-19 related diagnosis codes are present: B34.2, B97.29, J20.8, J22, J40, J80, J98.8, Z03.818, and Z20.828. The prior authorizations for these tests will be approved for 90 days.

The MHD is working to update the claims processing system to waive the prior authorization requirements for these tests when the above diagnosis codes are present. Providers must continue to submit prior authorization requests by using the web tool, Cyber Access, or by calling the MO HealthNet Call Center at (800) 392-8030, option 5, until the system work to waive the prior authorization requirements is complete.

The MO HealthNet Division is also waiving the co-payment for these codes.

COVID-19: Telehealth for Behavioral Health Providers (including Counseling/Psychology and ABA providers)

March 17, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

MO HealthNet covers Telehealth services. Please find information regarding Telehealth here: https://dss.mo.gov/mhd/providers/pdf/bulletin41-20-2018.pdf. You can also view the Missouri Telehealth law here: 191.1145, 191.1146, 208.670, and 208.677.

During this event, the MHD is allowing telehealth services to be provided to a MHD participant, while at home, using their telephone.

There is not a separate telehealth fee schedule. Reimbursement to health care providers delivering behavioral health services at the distant site is equal to the current fee schedule amount for the service provided.

This Hot Tip also applies to providers that are contracted with the Managed Care Organizations.

Adult Exceptions and DME supplies

March 16, 2020

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

In an effort to help contain the spread of the virus, temporary measures will be in place immediately to ensure our participants can still receive necessary items.

Effective immediately, prescribers seeking requests and/or renewal of Durable Medical Equipment (DME) items via Exceptions, Pre-Certification, and/or Prior Authorization may utilize face-time and/or telephone calls in place of a face-to-face office visit. 

  • Prescribers are still required to document the telephone encounter in the participant’s medical record and include notes regarding medical necessity of the items.
  • Prescribers must still complete an Exception Request form for items, as well as call the DME Pre-Certification Hotline (800-392-8030 option 2) for pre-certed items, or a DME Prior Authorization form submitted per protocol for requests of items.

If you have any questions, please call Provider Communications at 573-751-2896.

COVID-19: Provider Information (Physicians, Medical Clinics, FQHC’s, RHC’s) - Corrected

March 16, 2020

The MO HealthNet Division is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

The Department of Health & Senior Services (DHSS) webpage has the most current and comprehensive information.  DHSS’ 24 hour hotline is (877) 435-8411.  Please continue to review this information regularly.

MO HealthNet will conduct a webinar for Physicians/Medical Clinics, FQHC’s, RHC’s on March 18, 2020 at 10:30 a.m.  You may register here. 

This webinar will address billing, telehealth and resources.

COVID-19:  Laboratory

March 16, 2020

The MO HealthNet Division is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").  MO HealthNet providers who test patients for COVID-19 may bill using the newly created HCPCS codes U0001 and U0002.

HCPCS code U0001 is used specifically for CDC testing laboratories to test patients for SARS-CoV-2.  The rate for U0001 is $36.00.  HCPCS code U0002 allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2.  The rate for U0002 is $51.00.

The MO HealthNet Division is waiving the co-payment for these codes.

The MO HealthNet claims processing system will accept these codes on April 1, 2020 for dates of service on or after February 4, 2020.

COVID-19

March 9, 2020

The MO HealthNet Division is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").  MO HealthNet providers who test patients for COVID-19 may bill using the newly created HCPCS codes U0001 and U0002.

HCPCS code U0001 is used specifically for CDC testing laboratories to test patients for SARS-CoV-2.  HCPCS code U0002 allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2.

The MO HealthNet claims processing system will accept these codes on April 1, 2020 for dates of service on or after February 4, 2020.

Click here for more information on coronavirus from Department of Health & Senior Services.

Date Change: MO HealthNet Behavioral Health Provider Workshop

March 4, 2020

The MO HealthNet Division has changed the date of the provider workshop that was to be held on April 29, 2020 in order to avoid a conflict with the 2020 Missouri Children’s Trauma Network Training Summit. The behavioral health workshop will now be held on May 12, 2020.

The ABA workshop will still be held on April 16, 2020.

If you have questions about registration you can contact Constituent Education at MHD.provtrain@dss.mo.gov or 573-751-6683.

Complementary Health and Alternative Therapies for Chronic Pain Management: Pre-Certification Process and Billing

February 24, 2020

On April 1, 2019, the MO HealthNet Division (MHD) implemented statewide Complementary Health and Alternative Therapy Services for Chronic Pain Management.

The Complementary Health and Alternative Therapy Services program includes a combination of newly covered services: physical therapy, chiropractic therapy, and acupuncture, along with current coverage of cognitive-behavioral therapy (CBT) and non-opioid medication therapy.

Pre-certification of physical therapy, chiropractic therapy, and acupuncture services is a two-step process:

  1. The provider that prescribes the physical therapy, chiropractic, or acupuncture service must initiate the precertification process.
  2. The “performing provider” that will perform the service must access the precertification to complete the second step.
    • If the performing provider is part of a clinic or facility, the group (billing) NPI must be used in step 2.  The group (billing) NPI must be used to bill the claim as well. 
    • The individual performing provider NPI must be entered in performing provider field on eMOMED.

To obtain pre-certification, enrolled providers can call 800-392-8030, and choose Option 6, or use CyberAccess, a web tool that automates this process for MO HealthNet providers.
If you are not a CyberAccess user, contact the help desk at 888-581-9797 or 573-632-9797, or email cyberaccesshelpdesk@conduent.com to set up an account.

An approved pre-certification request does not guarantee payment. Providers must verify participant eligibility on the date of service by using the Interactive Voice Response (IVR) System at (573) 751-2896 or by utilizing eMOMED.

Providers that submit orders, prescriptions or referrals for Medicaid participants must have an active enrollment status with MO HealthNet in order for the billing provider’s claim to be approved. This is very important.  All ordering, referring, or prescribing providers are required by state and federal regulation to be enrolled with MHD.

  • For participants enrolled as members in a Managed Care health plan, providers will need to contact the member’s MO HealthNet Managed Care health plan directly for questions regarding their pre-certification procedures.

On January 1, 2020, MHD started covering chiropractic services for all MHD participants. These services are separate from the chiropractic services offered in the Complementary Health and Alternative Therapies for Chronic Pain Management program.  See this bulletin for information about these chiropractic services.

Physician & Laboratory Responsibilities for Drug Screening Services Billed to MO HealthNet: Reminders

February 11, 2020

The MO HealthNet Division (MHD) covers qualitative (presumptive) and semi-quantitative drug screening tests.  These tests report what drug classes (e.g., tricyclic antidepressants, phenothiazines, amphetamines, benzodiazepines, barbiturates, cannabinoids, methadone, opiates) are present (qualitative) and may provide an estimate (semi-quantitative) of the concentration.

MHD only covers quantitative (definitive) or “confirmative” tests if there is a positive screen for the drug class to be quantified and if the physician has documented the medical necessity in the patient medical record.

Physician offices or clinics may bill for initial drug screens performed at the point of care or independent and/or hospital laboratories may bill for screenings they perform.  Both providers cannot bill for the same date of service for the same participant.

The ordering physician has certain responsibilities:

  • The ordering physician must coordinate the billing of the drug screen tests with the performing laboratory. 
  • The ordering physician must document medical necessity in the patient medical record when ordering quantification of a drug class or a confirmatory drug test. 
  • The ordering physician must sign each order for drug screening tests by signing a paper order, or by electronic signature that conforms with the requirements of 13 CSR 65-3.050.  The requirements state that an electronic signature means a computer data compilation of any symbol or series of symbols executed, adopted, or authorized by an individual with the intent to be the legally binding equivalent of the individual’s handwritten signature. The use of biometrics does not constitute an electronic signature; however, biometrics may be used as part of electronic signature verification. A signature stamp does not constitute an electronic signature.

The performing laboratory has certain responsibilities:

  • The performing laboratory must ensure the physician has provided documentation of medical necessity when requesting quantification of a drug class or a confirmatory drug test.
  • The performing laboratory must not perform quantification of a drug class or a confirmatory drug test without documentation of medical necessity.

Diabetes Training Opportunity for Behavioral Health Providers!

February 3, 2020

We are alerting you to a world-class behavioral health training for psychologists and other mental health professionals developed by the American Diabetes Association on Saturday, February 29, 2020, in Kansas City. The workshop is co-sponsored by the Missouri Psychological Association (MOPA) and the Kansas City University of Medicine and Biosciences.

ABOUT THE WORKSHOP: Lead speaker will be Dr. Doug Tynan, former Director of the Office of Integrated Care for APA and now with the American Diabetes Association. He will be accompanied by two other nationally recognized instructors in this area.

The workshop is offering a total of 12 CEs --- 7 at the workshop and 5 more online.

COSTS/REGISTRATION: Regular cost of the workshop is $295, but MOPA or Kansas Psychological Association members will receive a special $45 discount. You may find out more at www.mopaonline.org/diabetes.

WHY THIS WORKSHOP IS IMPORTANT: The CDC reports that more than 100 million Americans are now living with diabetes or pre-diabetes. It is the 7th leading cause of death in our country. Behavioral health issues are common.

Given the right education and background, there is a special place for psychologists and behavioral health professionals who wish to provide care to this group and a special opportunity to expand your practice.

Laboratory Panel Codes

January 7, 2020

The MO HealthNet Division (MHD) claims processing system can only process claims for laboratory panels if all of the procedure codes and units that are included in the panel are completed and submitted on the electronic claim.

For example, the laboratory panel for procedure 80426 includes four units of 83001 and four units of 83002.  The provider must complete four units of 83001 and four units of 83002 in order to bill for 80426.  This claim can be submitted electronically.

If a provider only completes one unit of 83001 and one unit of 83002 they cannot bill 80426.  The claim for one unit of 83001 and one unit of 83002 must be submitted via paper claim to:

Department of Social Services
Attn:  Lab/Transplant Unit
PO Box 6500
Jefferson City MO  65102

Provider Resources for Bereavement Training

January 3, 2020

There are several bereavement training opportunities offered by Share (Pregnancy & Infant Loss Support).  Available are eight online training courses.  Live presentations of Companion training and Memory Making are scheduled in February 2020.

Trainings are all available free of charge from a Missouri Foundation for Health grant.  If you are interested in hosting a training or for further information, please email:  companion@nationalshare.org

To access these online learning courses: https://education.nationalshare.org/bundles/advanced-training-courses

Medicare Beneficiary Identification Number (MBI)

January 1, 2020

All Medicare claims submitted after January 1, 2020, are required to use the new MBI number. Effective January 1, 2020, claims filed without the MBI will deny for a mismatch of DCN/MBI combination not found in the MMIS.

The Medicare Access and CHIP Reauthorization Act (MACRA) required CMS to remove Social Security Numbers (SSNs) from the current SSN-based Health Insurance Claim Number (HICN)

Missouri Dual eligible Medicaid and Medicare participants have received their new cards.

If you have questions please call Provider Communications at 573-751-2896.