Retrospective Inpatient Certification Due to Incarceration
The MO HealthNet Division (MHD) requires all MO HealthNet enrolled hospitals in Missouri and bordering states to receive an admission certification. Retrospective (post-discharge) certification requests are only accepted when the participant has retroactive eligibility, or the hospital provider has a retroactive enrollment date. All other retrospective certifications will only be accepted on a case-by-case basis. The Inpatient Certification Request Form must be mailed with a copy of the patient’s medical record for days of the inpatient stay requiring review. When sending the retrospective requests, please indicate if the participant is “incarcerated, involuntarily confined to a state or federal prison, jail, detention facility or other penal facility” on the MO HealthNet inpatient request letter and attach (if applicable) the recoupment letter from Centurion.
Mail Retrospective Inpatient Certifications to:
CONDUENT
P.O. Box 105110
3425 West Truman Blvd
Jefferson City, MO 65110
This process will help streamline reviews and ensure requests are not dismissed due to participants' eligibility on admission.
Inpatient hospital admissions must be certified as medically necessary and appropriate before MO HealthNet reimburses for inpatient services.
For more information, please refer to the Inpatient Hospital Certification Reviews section of the Hospital Manual.