Electronic Visit Verification (EVV) – Soft Launch of Claims Validation

December 31, 2025

On January 7, 2026, MO HealthNet (MHD) will activate the soft launch of claims validation for services requiring EVV. MHD claims for these services will be compared to visit data in the EVV Aggregator Solution (EAS).

As of January 7, 2026, claims submitted to MHD must match the following verified visit data elements in EAS:
•    Department Client Number (DCN)
•    Date(s) of Service
•    Provider Medicaid ID
•    Procedure Code/Modifier(s)
•    Number of Units

During the soft launch period, MHD claims that not matching visits in EAS will not be denied; however, providers will be notified on their Remittance Advice (RA) via a Remittance Advice Remark Code. This will allow providers an opportunity to become familiar with the claims validation process to prepare for the application of hard edits, which will deny payment of the claims if there is no match in EAS.

For additional information, review the HCBS Provider Town Hall on Claims Validation from November 13, 2025:

Meeting Recording 11/13/2025 Presentation Slides 11/13/2025

For questions, contact Ask.EVV@dss.mo.gov. 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.

Scam/Fraud Email Alert

December 10, 2025

Missouri Medicaid Audit & Compliance (MMAC) issued an alert to all enrolled providers regarding a recent increase in cybersecurity threats targeting healthcare organizations, including Medicaid providers.

We have received reports of malicious actors impersonating MMAC in fraudulent emails. These emails may falsely claim that your provider account is subject to “arrest and closure” unless a late “Account Fee” is paid. These messages are not legitimate and are part of a phishing campaign designed to steal sensitive information and funds.

Key Cybersecurity Tips to Protect Your Practice:

Beware of Phishing Emails: Do not click on suspicious links or download attachments from unknown senders. Verify the sender’s email address and domain carefully. Official MMAC communications will come from a @dss.mo.gov domain. Be cautious of urgent or threatening language designed to provoke panic or immediate action. Look for signs of fraud such as misspellings, poor grammatical structure, and incorrect or unfamiliar acronyms. These are common indicators of phishing attempts. Electronic Fund Transfer (EFT) Requests: In general, MMAC will never initiate EFT changes via email. MMAC will never provide account numbers, routing numbers, or other sensitive banking information in an email. As part of the verification process, MMAC will ask providers to disclose old/closed account information. We allow for partial account and routing number disclosures such as XXXXX789. Always verify EFT change requests through a known MMAC contact or phone number. System Administrator Changes: Review and restrict administrative access to trusted personnel only. Do not respond to unsolicited requests to change system administrator credentials or access levels. General Best Practices: Use strong, unique passwords and enable multi-factor authentication (MFA) where possible. Keep your software and systems updated with the latest security patches. Train staff to recognize and report suspicious activity.

If you receive a suspicious email claiming to be from MMAC, do not respond. Instead, forward the message to MMAC.providerenrollment@dss.mo.gov and contact our office directly at (573) 751-3399 to verify its authenticity.

Your vigilance is critical in protecting Missouri’s Medicaid program and the sensitive data of MO HealthNet providers and beneficiaries.

Thank you for your continued partnership and commitment to cybersecurity.

HCBS Settings Final Rule 2025

October 10, 2025

This training is MANDATORY for Adult Day Cares, Doorways or Pathways to maintain enrollment (MO HealthNet) and license (DHSS). MMAC will not accept attestations this year from providers who fail to attend. At least one person from each enrolled Adult Day Care, Doorways or Pathways must attend.

Sessions will be held virtually via WebEx. We will start at 9:00 am and should last 90 minutes. You only need to attend ONE of the dates below to meet the requirement.

Registration Links:

Nov 4, 2025: HCBS SETTINGS FINAL RULE NOV 4, 2025, TRAINING SESSION

Nov 20, 202: HCBS SETTINGS FINAL RULE NOVE 20, 2025, TRAINING SESSION

This year is the FOURTH year, and it bears repeating, MMAC will not allow for attestations because providers couldn’t/wouldn’t/didn’t attend. This is a CMS (federal government) requirement to maintain your funding. Failure to have someone (owner or someone associated with your agency) attend either of these MANDATORY trainings will result in adverse actions from MMAC.

Once someone has attended the session, the agency will then be required to submit their annual HCBS Settings Self-Assessment and HCBS Assurances forms. For tracking purposes, please do not submit these forms until after the training session. Forms are available on the MMAC website and I will also go over where you can find them during the training sessions.

Questions, please contact MMAC Contracts Unit as mmac.hcbssettings@dss.mo.gov

Tags: Final Rule, HCBS Settings

FALL 2025 UPDATE MEETING FOR HOME AND COMMUNITY BASED PROVIDERS

September 19, 2025

The registration links for the October 22 & 23, 2025, HCBS Provider Update Meetings have been added to the MMAC website – Update Meeting webpage Provider Update Meetings.

If you are a Designated Manager (DM) for an in-home or a certified CDS Manager for consumer directed services provider, you are required to attend one of these sessions each year in order to maintain your certification. The registration form has been updated due to MMAC having over 20,000+ DMs and 1000+ CDS Managers. Please indicate on the form if you are DM or CDS Manager and the last four digits of SSN to make sure credit of attendance is indicated to the correct person.

Providers Required To Maintain Records For Six (6) Years

June 23, 2025

Recently, Missouri Medicaid Audit and Compliance (MMAC) learned that not all providers are aware that the Missouri Medicaid Audit & Compliance Title XIX Participation Agreement was updated effective March 15, 2025. Section six (6) of the agreement was updated to reflect providers are required to maintain records for six (6) years, as required by regulations, instead of five (5) years documented in the previous agreement.

All updated documents and requirements for each specific provider type can be found at the following link: https://mmac.mo.gov/revalidation-requirements/.

MMAC recommends providers use the revalidation requirements link https://mmac.mo.gov/revalidation-requirements/, when completing a new enrollment or revalidation. Using the link will ensure all correct forms are being used instead of relying on older, outdated forms that may have been saved to a local computer. Using the link and correct forms will prevent rejections of enrollments/revalidations due to old documents being used, which will lead to a more timely and efficient approval process.

Any questions can be sent to mmac.revalidation@dss.mo.gov or by calling (573) 751-5238.

MMAC appreciates your collaboration and partnership. We thank you for the critical services you provide to our Medicaid community.

Sincerely,

Richard Ferrari,
Director-MMAC

EVV Phase II—Claims Validation

June 5, 2025

EVV Phase II—Claims Validation

This message applies to Personal Care and In-Home Health Care Service providers required to use EVV.

Claims Validation

Missouri Code of State Regulation 13 CSR 70-3.320 mandates the use of Electronic Visit Verification (EVV) when providing personal and in-home services to Medicaid eligible participants. Per guidance from the Centers for Medicare and Medicaid Services (CMS), the next phase of EVV implementation requires the validation (matching) of claims to the data entered for each visit in the EVV Aggregator Solution (EAS) before payment of the claim.

The state will update their systems to implement the claims validation process. This may have an impact on the payment of claims for services that require the use of EVV. To minimize the risk of denied claims following these changes, providers are strongly encouraged to be fully compliant with existing EVV requirements. For more information on these requirements, refer to the Provider Responsibilities below and the EVV webpage.

Following full implementation of this enhancement, claims that do not have a matching visit in in EAS will be denied and payment will not be issued.

Claims Validation Soft Launch

A “Soft Launch” of EVV claims validation is planned for Fall 2025. This soft launch will allow providers time to familiarize and educate themselves with the process, and to assist in preventing denial of claims following the full implementation. The soft launch is expected to be a period of approximately three months.

When the soft launch begins, RAs will include a notification for claims that indicates when the information in EAS did not match the information submitted on the claim. Throughout the soft launch, claims will continue to pay even if there is not a matching visit in EAS.

The method used for submitting claims has remain unchanged. However, an additional systemic validation step will occur comparing the claim to the visit data in EAS. Each claim for EVV services must align with a ‘verified’ visit in EAS, matching the following data elements:

Individual/Participant ID (DCN) Date (s) of Service Provider Medicaid ID Procedure Code/Modifier Number of Units

If the information in EAS does not match the information submitted on the claim, providers will receive an informational exception on their Remittance Advice (RA). These claims will be denied once the full implementation of claims validation begins.

Claims Validation Full Implementation

Following the soft launch, claims validation will be fully implemented. Once implemented, any claim submitted without a corresponding visit in EAS or claims that do not match all the data elements listed above, will be denied and will not pay. Visits in EAS must be in a ‘verified’ status. Providers will receive notification of a denial on their RA. The provider must log into EAS to identify any missing or inaccurate information. Corrections must be made in the provider’s EVV system, then resent to EAS. At that time, the claim must be resubmitted for payment.

Provider Responsibilities

To prepare for this change and continue to be paid for claims without interruption after claims validation is fully implemented, providers must take the following actions:

Ensure EVV is used for all visits for any service requiring the use of EVV, entered at the time services are provided. A list of services can be found on the EVV webpage.

Confirm visits are being displayed in the appropriate accounts based on the Provider Medicaid ID using the following: Personal Care Provider Services Reference Table Home Health Care Provider Services Reference Table

Ensure the provider’s chosen EVV system is sending the visit data to EAS at least once a day.

Login to EAS at least once a week as required by 13 CSR 70-3.320 (2)(K) and ensure all visits are ‘verified’, correct any errors found, and resubmit corrected information to EAS. After full implementation of claims validation, visits must be in a ‘verified’ status to be considered for payment.

For questions, view the EVV Claims Validation Presentation, visit the EVV webpage or contact Ask.EVV@dss.mo.gov.

PUBLIC NOTICE

February 20, 2025

Based on the actions of the Centers for Medicare and Medicaid Services, notice is hereby given that the agreement between the Missouri Department of Social Services and Liberty Health & Wellness as a provider of services in the MO HealthNet (Medicaid) program, will be terminated at the close of business March 7, 2025.

To facilitate the orderly relocation of MO HealthNet beneficiaries, for residents admitted February 24, 2025, or earlier, payment may continue for up to 30 days for services furnished after March 7, 2025.

Todd Richardson, Director

MO HealthNet Division

Department of Social Services

Tracy Niekamp, Administrator

Section for Long-Term Care Regulation

Department of Health and Senior Services

FROM THE DIRECTOR

December 30, 2024

The Missouri Medicaid Audit and Compliance Unit (MMAC) expects all enrolled MO HealthNet providers to keep their information up to date as required in the Code of State Regulations. Any changes can be reported to MMAC by using the Provider Update Request. Please fax the form and any accompanying documents to 573-634-3105. Questions? Please contact MMAC Provider Enrollment at MMAC.ProviderEnrollment@dss.mo.gov. 13 CSR 65-2.020(11) The provider shall advise MMAC, in writing, on enrollment forms specified by MMAC, of any changes affecting the provider’s enrollment records within ninety (90) days of the change, with the exception of change of ownership or control of any provider which must be reported within thirty (30) days. (A) The Provider Enrollment Unit within MMAC is responsible for determining whether a current MO HealthNet provider record shall be updated, or a new MO HealthNet provider record is created. A new MO HealthNet provider record is not created for any changes, including but not limited to change of ownership, change of operator, tax identification change, merger, bankruptcy, name change, address change, payment address change, Medicare number change, National Provider Identifier (NPI) change, or facilities/offices that have been closed and reopened at the same or different locations. This includes replacement facilities, whether they are at the same location or a different location, and whether the Medicare number is retained or if a new Medicare number is issued. A provider may be subject to administrative action if information is withheld at the time of application that results in a new provider number being created in error. The division shall issue payments to the entity identified in the current MO HealthNet provider enrollment application. Regardless of changes in control or ownership, MMAC shall recover from the entity identified in the current MO HealthNet provider enrollment application liabilities, sanctions, and penalties pertaining to the MO HealthNet program, regardless of when the services were rendered. To ensure that the provider’s information update is completed in timely manner, the provider must consider the following when submitting the provider update request form to MMAC; Signature: accepted signature by MMAC is either an ink signature or one of the approved electronic signatures. Individual Provider’s signature is required in the following updates: o Main practice location update. o Provider is updating enrollment from 03 – billing to 13 – performing. o Change in the pay to information. For entity’s Provider Update request, the signer must be authorized personnel that is listed with MMAC on the provider’s ownership as a managing employee or an owner. Most Missouri Medicaid providers can update the additional practice location for their enrollment on EMOMED. Except the following: o Provisionally licensed counselors o Advanced Nurse Practitioners o Federally Qualified Health Center o Dialysis Clinic o Ambulatory Surgery Center o Rural Health Clinic If the provider is having technical issues with adding or removing the additional practice locations, then they will need to contact EMOMED Helpdesk at: (573) 635-3559.

MMAC’s Provider Communication Portal Has Closed

December 24, 2024

MMAC has closed the Provider Communication Portal. MMAC and other key stakeholders have been hard at work to finalize a contract for a new, comprehensive Provider Enrollment System. The new system will be used for new provider enrollments and revalidations. The new Provider Enrollment System will also have an integrated (rather than stand-alone) Self-Service Portal.

As MMAC embraces new technology we want to lessen the inconvenience for our providers. Therefore, MMAC has discontinued the use of the Provider Communication Portal, which was launched in August 2024.

MMAC is returning to our previous methods of communication with providers via email and phone. Providers still have various ways to contact MMAC’s Provider Enrollment Unit by emailing mmac.providerenrollment@dss.mo.gov, the Contracts Unit at mmac.ihscontracts@dss.mo.gov, or the Revalidations Unit at mmac.revalidation@dss.mo.gov.

More information will be forthcoming regarding the launch of the new Provider Enrollment System. Projected date for the new Provider Enrollment System is mid-2026.

Thank you for your patience and support as we seek the best technological advancements to best serve you and streamline the work for MMAC. Don’t hesitate to contact us with any questions at (573) 751-3399.