Investigations & Enrollment
MMAC investigators are responsible for conducting investigations into allegations of fraud, waste and abuse by providers and participants. Investigators conduct interviews with witnesses as well as those suspected of violating state regulation, state statute and federal regulations.
In the event the investigation reveals a credible allegation of fraud by a provider, MMAC will forward the information to the Medicaid Fraud Control Unit (MFCU), or other prosecutorial entity for review.
If the investigation reveals probable cause of fraud by a participant, MMAC will forward the information to the Division of Legal Services Unit for review.
The Provider Enrollment Unit is responsible for enrolling new providers in accordance with 13 CSR 70-3, maintaining provider records, and answering provider inquiries related to enrollment for all MO HealthNet provider types. The Provider Enrollment staff is authorized and required to determine when new provider numbers are issued or when a current provider number will be updated.
After a MO HealthNet provider number has been issued it must be used with all transactions pertaining to MO HealthNet. If a separate provider number has been issued for different location/practices, the provider is responsible to ensure the appropriate provider number is used when billing. Learn more about provider enrollment.
Contracts & Terminations
The Contracts and Terminations staff have two primary responsibilities within MMAC.
The Contracts staff reviews proposals submitted by entities who wish to contract with MMAC to provide In-Home Services (IHS) or Consumer Directed Services (CDS) to participants authorized by the Department of Health and Senior Services (DHSS).
The Terminations staff is responsible for terminating providers from the Medicaid program and working with the Centers for Medicare and Medicaid Services to ensure appropriate notification is made when a provider is terminated.
Provider Manual Audits
MMAC is responsible for reviewing MO HealthNet provider manuals, corresponding state statutes, and state regulations, and to report any inconsistencies between them to the MO HealthNet Division for appropriate corrective action.