Date
MO HealthNet often receives only partial information on PA requests for medication. This partial information leads to an increase in call and fax volume at the helpdesk and causes increased calls and faxes to your offices to obtain the necessary information, and slows down the PA process.
Please help us respond quickly to your requests by reviewing the information below.
Pharmacies or prescribers can call the Pharmacy Help Desk line at 1-800-392-8030, option #3, Monday-Friday, 8 am-9 pm, or Saturday and Sunday, 8 am-6 pm. In addition to phone calls, providers may submit requests through CyberAccess or by faxing a Drug Prior Authorization form to 573-636-6470. To become a CyberAccess user, contact the Conduent help desk at 888-581- 9797.
- Complete all PA forms in their entirety before submission.
- MO HealthNet does not accept PA requests from third-party vendors like CoverMyMeds and ZAPPRX. All requests must originate from the prescriber’s office or pharmacy with the established patient relationship. Additionally, MO HealthNet will not provide any participant or claims information to third-party vendors nor accept information or documentation from a third-party vendor.
- Incomplete PAs will be sent back without a decision, requesting the missing information.
- Pharmacy PA forms and edit criteria are available on MO HealthNet’s website.
- Send all documentation in the same fax rather than multiple faxes. Do not send in duplicate faxes.
- Send all documentation in chronological order.
- Only send progress notes with a PA form.
- Sending progress notes or office notes beyond the most recent notes slows the process in multiple ways. It requires additional fax time, data entry time, and evaluation time.
- MO HealthNet has several drug-specific PA forms. Please check the form to ensure all applicable requested information is sent with the PA form.
- Stay updated on MO HealthNet criteria, as PA criteria change often.
- MO HealthNet’s website comprehensively describes the criteria for medications requiring a PA.
- Reduce drug PA burden.
- Almost 33% of drug PAs for MO HealthNet are due to a lack of a supporting diagnosis. MO HealthNet has multiple methods for obtaining diagnoses. The quickest option is to include the diagnosis code on your e-prescriptions so pharmacies can submit it with the drug claim. MO HealthNet allows pharmacies to submit diagnosis codes with the pharmacy claim in real-time; most pharmacy systems can automatically submit diagnosis codes included on the e-prescriptions. By having the supporting diagnosis code with your e-prescriptions, you may be able to reduce your prior authorization requests by 30%.
Some common classes where the patient’s diagnosis is required include:- Antipsychotics
- Fibromyalgia
- Opioids
- Topical Retinoids
- Almost 33% of drug PAs for MO HealthNet are due to a lack of a supporting diagnosis. MO HealthNet has multiple methods for obtaining diagnoses. The quickest option is to include the diagnosis code on your e-prescriptions so pharmacies can submit it with the drug claim. MO HealthNet allows pharmacies to submit diagnosis codes with the pharmacy claim in real-time; most pharmacy systems can automatically submit diagnosis codes included on the e-prescriptions. By having the supporting diagnosis code with your e-prescriptions, you may be able to reduce your prior authorization requests by 30%.