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. Provider Education representatives want to ensure providers are given the full allotted time to go over the listed claim(s) type that pertain to the Webinar.
Please access the Claims Processing Schedule for Fiscal Year 2015, for the updated claims processing schedule located on the MO HealthNet website.
Claims Processing and Payment Schedule for Fiscal Year 2015
Inquiries regarding proper claim filing, claim denials, Remittance Advices, and participant eligibility should be directed to the Provider Communications Unit at (573) 751-2896. The Provider Education Unit should be contacted for training and education on proper billing methods and procedures for MO HealthNet Claims.
Some crossover claims cannot be processed in the usual manner for one of the following reasons:
The Benefit Matrix is a practical tool now linked from the MO HealthNet Division’s Provider Participation page. Once a provider navigates to the Provider Participation page, the Benefit Matrix may be found on the left side of the page in the General Information section, underneath the “MO HealthNet Guide — Puzzled by the Terminology?” link. The Benefit Matrix is an Excel spreadsheet that outlines the various benefits and limitations for each of the MO HealthNet programs, as well as cost-sharing, and co-pay amounts.
Some MO HealthNet participants are restricted (or locked-in) to a provider or providers, such as a certain physician/clinic and/or pharmacy, where the participant can receive treatment or services. A provider checking patient eligibility is given the names and phone numbers of the lock-in providers. Payment of services for a locked-in participant cannot be made to other providers, except for emergency services or authorized referral services.
Reminder — the date of service for items such as dentures, hearing aids, eyeglasses or durable medical equipment, should be the date of delivery or placement of the device or item. The date of service is not the date the device or item is ordered or fabricated. Providers should reference Missouri State Regulation 13 CSR 70-3.100(7)(D)(7).
Providers continue to question the explanation of the codes shown on their claim confirmation report, as well as their remittance advices.
MO HealthNet no longer reports MO HealthNet-specific explanation of benefits and exception message codes on any type of remittance advice. As required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) national standards, administrative code sets, such as Claim Adjustment Reason Codes, Remittance Advice Remark Codes, and NCPDP Version 5.0 Reject Codes for Telecommunication Standard are used.
Please take a few minutes to double-check faxes you may send to the State. When faxes leave a location, they are “stamped” with a Calling-Station ID across the top of the fax by the receiving agency. This Calling-Station ID is programmed into the fax machine and tells the receiving agency the fax number of the sender.
Update on Recovery Audit Contractor (RAC) and Medicaid Integrity Contractor (MIC) Activities.
Section 6411 of the Affordable Care Act, Expansion of Recovery Audit Contractor (RAC) Program, amends section 1902(a)(42) of the Social Security Act and requires states to contract with a RAC vendor and allows states to reimburse contractors who assist in the identification and recovery of improper payments. Missouri contracted with Cognosante, LLC in December, 2011 to serve as Missouri’s RAC.
