Inpatient Certification Reconsideration Process
An attending physician, hospital, or participant who disagrees with Conduent’s (MO HealthNet Division’s review authority) initial denial determination for an inpatient certification is entitled to reconsideration by Conduent. The reconsideration may be requested before or after the participant is discharged from the hospital.
The request for reconsideration must be made within three (3) working days of receiving the denial letter from Conduent, if the participant is still an inpatient, or within 60 calendar days if the participant has already been discharged.
Requests for reconsideration must be mailed using the Inpatient Certification Request and include all pertinent medical documentation. The request and documentation must be mailed directly to the applicable address below to avoid a delay in the reconsideration request.
- USPS Mail - Conduent: P.O. Box 105110 Jefferson City, MO 65110
- FedEx/UPS Mail - Conduent: 3425 West Truman Jefferson City, MO 65109
The request for reconsideration is conducted by a Conduent physician reviewer who has had no previous involvement in the case. The physician is board-certified or board-eligible in the specialty that matches the care under review, except in cases where meeting this requirement compromises the efficiency and effectiveness of the review. The reconsideration process involves reviewing all medical records, including the information used to make the initial determination.
Refer to Section 2.27 of the Hospital Manual for further information. For questions regarding a request for reconsideration, contact Conduent by calling (800) 766-0686, Option 0. For other questions, please contact Provider Communications via eMOMED or call (833) 222-7916.