Non-Covered vs. Non-Allowable Services
Providers commonly are confused between “non-covered” and “non-allowable” services. The various provider manuals contain sections, which describe these services.
WebEx Meetings Conducted by Provider Education and Training Unit
Provider Education Unit would like to advise provider’s that Webinar’s are now scheduled and conducted with WebEx Meeting. This new feature will assure that providers are still given full directions and allotted scheduled time for questions.
Scheduled Webinars for Listed Claim Types
MO HealthNet Division (MHD) Provider Education Unit provides Webinar based trainings to enrolled providers. Please access the Webinar Training schedule to attend any training that pertains to the provider’s specific training needs.
Non-QMB, Medicare Part C Plan
MO HealthNet Division (MHD) will process claims in accordance with the established MHD coordination of benefits policy for Non-Qualified Medicare Beneficiary (Non-QMB) participants enrolled in a Medicare Advantage/Part C plan. Please refer to the policy in the MHD provider manuals, General Section 5 - Third Party Liability.
Participant Lock-In
Some MO HealthNet participants are restricted or locked-in to authorized MO HealthNet providers of certain services to help the participant use the MO HealthNet program properly. When the participant has an administrative lock-in provider, the provider’s name and telephone number are identified on electronic billing website emomed or the IVR (Interactive Voice Response) system accessed from 573-751-2896, when verifying eligibility.
Electronic Claim Submission
A provider wishing to submit claims or attachments electronically or access the Internet website on emomed must be enrolled as an electronic billing provider.
Providers wishing to enroll as an electronic billing provider may register online on emomed or contact the Wipro Infocrossing Help Desk at (573) 635-3559.
Providers are unable to access emomed without proper authorization. An authorization is required for each individual user.
Third Party Resources
MO HealthNet funds are used after all other potential resources available to pay for the medical service have been exhausted. Please refer to the provider manual General Section 5 – Third Party Liability (TPL).
MO HealthNet Spenddown Provider Form
Spenddown refers to the amount of medical expenses that are a participant’s financial responsibility, which is similar to an insurance deductible. Participants may choose to have the providers submit incurred medical expenses to the spenddown unit on behalf of the participant.
Bundled Value Code - Medicare UB-04 Part A Institutional Claims
The “Bundled Value Code” field is a new field located on the electronic Medicare UB-04 Part A Institutional crossover claim form. When entering a claim in emomed, this field is located within the Header section of the online claim form. Providers may reference the Emomed Help button located on the upper right corner of the online claim form for definitions of the fields.
Provider Participant Page
MO HealthNet Division (MHD) provides useful information for providers of all types, who participate in the MHD programs. Providers and their staff can find multiple links from the Provider Participation web page or links may be obtained from emomed, under the feature links section, Provider Information.