All MO HealthNet providers are required by state regulations to disclose certain information to Missouri Medicaid Audit & Compliance (MMAC) during their initial enrollment or revalidation processes. Those mandatory disclosures include:
The name, address, date of birth, social security number, or other tax identification number of any person with a five percent (5%) or more ownership or control interest in the applying provider and any subcontractors in which the applying provider has a five percent (5%) or more interest; Whether any person with an ownership interest in the applying provider is related to another person with ownership or control interest in the applying provider as a spouse, parent, child, or sibling; Whether any person with an ownership or control interest in any subcontractor in which the applying provider has a five percent (5%) or more interest is related to another person with ownership or control interest in the applying provider as a spouse, parent, child or sibling. The name, address, date of birth and social security number of any managing employee of the applying provider.
Disclosures must be updated within thirty-five (35) days of any changes in information required to be disclosed.
MMAC is required to collect the disclosed information to screen individuals and legal entities with ownership and control interest against various state and federal exclusion databases.
Please review 13 CSR 65-2.020 for more information or email MMAC.ProviderEnrollment@dss.mo.gov if you have questions.
MMAC utilizes MO HealthNet (MHD) provider hot-tips and provider bulletins to keep providers informed about its activities. MMAC website updates will be sent to MHD in the form of hot-tips or bulletins for providers. We encourage providers to sign up for MO HealthNet News.
Provider Update Training is scheduled for April 21, 22, and 23, 2015. This Provider Update Training is for Home and Community Based Services Providers. Please open this notification and click on the link for additional information.
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.
ContractsThe 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).
RevalidationsState and federal regulations require all currently enrolled Medicaid providers to revalidate their enrollment at least every five (5) years.
State and federal regulations (13 CSR 65.2 and 42 CFR 455.414) require all enrolled Medicaid providers to do certain things:
Revalidate their information at least every five (5) years Certain providers must pay an application fee Providers must be screened according to categorical risk level Ordering, referring, and prescribing providers must be enrolledPlease click on “Providers” at the top of this page, and choose “Provider Enrollment” to see further information on each one of these categories.
In March, 2014, MMAC posted an update to the RAC (Recovery Audit Contractor) and MIC (Medicaid Integrity Contractor) activities on its website. See the archived post here March 2014 RAC and MIC update. Cognosante, LLC is the RAC for Missouri. Section 6411 of the Affordable Care Act, Expansion of Recovery Audit Contractor (RAC) Program, amends section 1902(a)(42) of the Social Security Act and requires states to contract with a RAC vendor and allows states to reimburse contractors who assist in the identification and recovery of improper payments.
Should you receive any communication from an entity representing itself on behalf of Missouri Medicaid Audit and Compliance (MMAC), or Cognosante, and you are concerned about the legitimacy of the person or company, you should contact MMAC at (573) 751-3399 to verify the communication or request is legitimate.
In 2015, the RAC will finish its work on outstanding pharmacy and durable medical equipment (DME) audits, and will begin conducting audits of hospital billing submitted by enrolled Missouri hospital providers. The RAC may request documentation to support billing of outpatient encounters, including professional and facility services in the emergency room. The RAC will review paid claims for proper billing of both professional and facility services, and the appropriate utilization of facility resources, such as supplies and facility charges. Documentation requests may include requests for itemized statements, medical records, medication administration records, radiology interpretations, and laboratory results to support the claims submitted for payment.
MO HealthNet reimburses eligible participants or nonemergency medical transportation (NEMT) providers for medically necessary transportation only if a participant does not have access to transportation services that are available free of charge. For more guidance on the NEMT program and its other requirements, please read the regulation (13 CSR 70-5.010) at https://www.sos.mo.gov
The MO HealthNet Division also has information about NEMT services on their website at https://dss.mo.gov/mhd/participants/pages/medtrans.htm
MO HealthNet also covers ambulance services for eligible participants if they are emergency services and transportation is made to the nearest appropriate hospital. Further information about the Emergency Ambulance Program is located in 13 CSR 70-6.010 at https://www.sos.mo.gov
MMAC encourages providers, who may call on behalf of participants, to be familiar with the program rules and requirements.
Missouri Medicaid Audit & Compliance (MMAC) will begin implementing new provider enrollment procedures during 2015 to comply with federal laws requiring all Medicaid providers to revalidate their state enrollments at least every five years. Other changes will include conducting pre-enrollment site visits for certain provider types and collecting a federally mandated enrollment application fee from institutional providers (individual physicians, dentists and individual non-physician practitioners are exempt from paying the fee).
Providers can ensure receiving information in a timely manner by making sure we have your current address, telephone number(s), e-mail address and the name of your primary contact person. Please submit any changes or updated information to MMAC by downloading the “Provider Update Request” form at https://mmac.mo.gov/providers/provider-enrollment/new-providers/provider-enrollment-forms. The completed forms can be scanned and sent by e-mail to mmac.providerenrollment@dss.mo.gov or they can be faxed to the Provider Enrollment Unit at (573) 751-5065.
Be sure to check MMAC’s website regularly to get information on upcoming changes and other helpful tips for MO HealthNet providers.
The Missouri Medicaid Audit & Compliance (MMAC) Provider Enrollment Unit (PEU) has processed several applications for enrolling Physician Assistants. PEU personnel assign provider numbers and create the appropriate electronic accounts, permitting the new providers to begin submitting claims for health care services provided to Medicaid participants. At this time, MO HealthNet Division and its fiscal agent are still completing required system work to enroll and reimburse Physician Assistants.
Once MMAC receives notification that the system work is complete, PEU personnel will assign the provider number and finalize creation of the enrollment records. MMAC will backdate the effective date of the new Medicaid provider enrollments to the date the applications were originally received. In the meantime, providers can continue getting reimbursed under their current billing arrangements, or they can hold their claims until their provider numbers have been assigned. MO HealthNet permits providers to file claims for reimbursement up to one year after the services were actually provided.
