Provider Review & Lock-In

The Provider Review & Lock-In section of MMAC monitors MO HealthNet program compliance by providers, and in some instances participants.

The Provider Review Section conducts onsite and desk review of post-payment MO HealthNet claims to ensure appropriate payments were made and that providers are billing and providing services in accordance with federal and state regulations and MO HealthNet requirements.

The Participant Lock-In Section within the Provider Review and Lock-In Section monitors claims and responds to referrals where potential fraud or abuse may be attributed to a participant.