State and federal regulations (13 CSR 65-2 and 42 CFR 455.460) require Missouri Medicaid Audit and Compliance (MMAC) to collect an application fee from all new and revalidating “Institutional” Medicaid providers. “Individual” providers such as physicians, dentists and other individual non-physician practitioners are not required to pay the application fee.
The application fee is currently set at $569.00, and it will increase to $586.00 on January 1, 2019.
Click here to read more about the application fee and hardship waivers
MMAC is pleased to announce that a new Provider Revalidation Portal will be available for MO HealthNet providers starting January 7, 2019. Federal and state regulations require all providers to revalidate their Medicaid enrollment at least every five years. To make that process quicker and easier, providers will be able to complete their revalidation applications using the same EMOMED portal that is used to submit electronic claims to MO HealthNet. Approximately 15,000 of the 60,000+ currently enrolled MO HealthNet providers will need to complete revalidation by June 30, 2019.
Starting January 7, 2019, emails will be sent to providers and administrators; letting them know a provider they manage is due for revalidation. The email will direct the providers and administrators to sign onto EMOMED and access the Revalidations Portal to see which of their providers need to revalidate. The providers and administrators will be able to view the provider’s current enrollment information. They will be able to edit any outdated or incorrect information, verify the updated information, and upload any required documentation needed to complete the revalidations process. They will then be able to submit the completed revalidation application to MMAC via EMOMED.
Additional information will be posted under the Revalidations section of MMAC’s web page on January 7th. The entire MMAC team wishes everyone a safe and happy holiday season !!
Warmest Regards – Dale Carr, MMAC Director
Current state and federal regulations (13 CSR 65-2 and 42 CFR § 455.410) require Ordering, Prescribing, or Referring (OPR) physicians or other professionals providing services under the state plan or under a waiver of the plan to be enrolled as participating providers with the state Medicaid agency. Federal regulation 42 CFR § 455.440 requires all Medicaid claims for payment of items and services that were ordered, prescribed, or referred to contain the National Provider Identifier (NPI) of the physician or other professional who ordered, prescribed, or referred such items or services.
Drug claims with a date of service on or after October 14, 2018, will deny unless the prescriber is actively enrolled with MO HealthNet.
All outpatient or medical claims billed using the National Drug Codes (NDC) with the appropriate HCPCS or CPT procedure code for the medication administered must also contain an actively enrolled MO HealthNet prescriber. This includes but is not limited to C-codes, G-codes, J-codes, Q-codes, S-codes and non-VFC vaccination CPT codes. For medications billed on outpatient claims the attending provider is treated as the prescriber and for medical claims the rendering provider is used.
In addition, effective October 14, 2018, MO HealthNet will no longer accept a Drug Enforcement Administration (DEA) number in the “Prescribing Provider ID” field on drug claims. Providers must submit the actively enrolled prescribing provider’s NPI in the “Prescribing Provider ID” field. Claims submitted with a date of service on or after the effective date with a DEA number in the “Prescribing Provider ID” field will deny.
The Missouri Medicaid Audit and Compliance Unit (MMAC) provides an OPR Application that can be downloaded (link) or utilized as a fillable PDF form (link). MMAC’s provider enrollment personnel will expedite all OPR applications received. Please fax completed applications to (573) 634-3105.
Authorization for emergency medications only may be obtained by contacting Pharmacy and Clinical Services at (573) 751-6963. Prescribers should immediately submit an OPR application to MMAC or a subsequent override authorization may be denied.
The “Medicaid and CHIP Managed Care Final Rule” and 42 CFR 438.602(b)(1), require states to screen and enroll, and periodically revalidate, all network providers of Managed Care Organizations (MCOs); including Ordering, Prescribing, and Referring (OPR) providers. This requirement was effective January 1, 2018. Missouri Medicaid Audit & Compliance (MMAC) enrolls all health care providers for the Missouri Medicaid program operated by MO HealthNet.
The MCOs contracted with MO HealthNet have been notified that their network providers need to be enrolled with MMAC, or have submitted an enrollment application to MMAC, by the close of business on October 31, 2018. The MCOs have been directed to remove any of their network providers who have not submitted an enrollment application to MMAC by that date.
Providers enrolled with any of the three MCOs contracted with MO HealthNet, but who are not yet enrolled with MMAC, should do so before the deadline. MMAC has streamlined MCO network provider application forms for individual providers (Individual Application) or organizational providers (Organizational Application). Providers completing the MCO network provider enrollment application will not submit claims to MO HealthNet, nor will they be required to provide any services to Medicaid Fee for Service participants.
Providers who are enrolled with MCOs under more than one National Provider Identifier (NPI) will need to make sure each of those NPI numbers are enrolled with MMAC.
Any questions regarding enrolling with MMAC as a MCO Network Provider should be submitted to MMAC.ProviderEnrollment@dss.mo.gov
MMAC employees conduct announced or unannounced reviews (audits) of MO HealthNet providers to collect documentation supporting claims that were submitted for services provided to Medicaid participants. Providers are increasing utilization of Electronic Health Record (EHR) and/or Electronic Visit Verification (EVV) systems to generate and retain their documentation of services provided. Those records are usually pulled up on the EHR or EVV system by one of the provider’s authorized users and then transferred onto a CD, DVD, or thumb drive for MMAC personnel.
MMAC is noticing that the staff responsible for managing providers’ EHR and/or EVV systems frequently encounter difficulties producing the requested records during MMAC’s visit. MMAC encourages all MO HealthNet providers to make sure appropriate staff are familiar with their EHR or EVV system and know how to retrieve and transfer records for specified Medicaid participants and service dates.
