Verifying Eligibility for MO HealthNet Participants and Managed Care Members

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Verifying Eligibility for MO HealthNet Participants and Managed Care Members

After determining whether a participant has or may have MO HealthNet coverage, providers are responsible for verifying their eligibility. Because eligibility is updated daily, this check must occur before every visit. To receive reimbursement, the participant must be actively eligible on the exact date of service. This requirement applies to both Fee-For-Service participants and Managed Care members.

There are two ways to verify a participant’s eligibility. Eligibility verifications occur in real time, so a response is returned immediately.

  1. In eMOMED – For step-by-step instructions, review the Provider Overview Guide and access the ‘Checking Eligibility in eMOMED’ lesson.
  2. Call Provider Communications at (833) 222-7916 or (573) 751-2896
    1. Choose Option 1
    2. Verify eligibility using any of the following options:
      1. Option 1 – MO HealthNet ID found on the front of the participant’s MO HealthNet Identification Card
      2. Option 2 – Social Security Number
      3. Option 3 – Case Head ID and the dependent’s date of birth

Eligibility verifications can also be submitted as a batch submission. Batch eligibility verifications are returned to the user within 24 hours. For assistance with batch submissions, contact the Provider Technical Help Desk at Help.Desk@emomed.com or by calling (573) 635-3559.  
 

For Managed Care members, providers should also verify eligibility with the appropriate Managed Care health plan before each visit. 
 

For additional resources, refer to the Education and Training Resources page and/or sign up for a live webinar by accessing our Provider Training Calendar. Email MHD.Education@dss.mo.gov for more information.