Beginning January 1, 2018, according to federal regulation 42 CFR 438.602, states must screen and enroll, and periodically revalidate, all network providers of managed care organizations (MCOs). This requirement applies to ordering, prescribing, and referring “OPR” providers in the managed care setting, as well.
This requirement does not cause managed care network providers to see Fee-For-Service (FFS) Medicaid clients. Providers who are already enrolled with MO HealthNet as a FFS or OPR provider do not need to submit another application as a MCO Network Provider.
Missouri Medicaid Audit & Compliance has created two enrollment application forms for MCO network providers to enroll with MO HealthNet as a non-participating provider. Click here for the individual physician or non-physician practitioner provider application and here for the organizational provider application.
MCO network providers may begin submitting their MO HealthNet applications to MMAC immediately.
Please submit any questions you may have to MMAC.ProviderEnrollment@dss.mo.gov
Dear Stakeholder:
Re: Governor Eric Greitens’ Executive Order 17-03
Due to public interest, the Missouri Department of Social Services’ public rule review comment period has been extended and will now end on October 15, 2017. And, we have added four more public hearings. The public is welcome to come at any time between 10:00 a.m. and 1:00 p.m. and provide one-on-one comments to representatives of DSS about the agency’s rules.
Hannibal Monday, September 11
10:00 am – 1:00 pm
Children’s Division Office
3055 Holman Drive Joplin Tuesday, September 19
10:00 am – 1:00 pm
Children’s Division Office
601 Commercial Cape Girardeau Monday, September 25
10:00 am – 1:00 pm
Children’s Division Office
471 Siemer Drive St. Joseph Tuesday, October 3
10:00 am – 1:00 pm
Children’s Division Office
525 Jules Street
If you believe one of these or any of our many other topics may affect you, please review our rules at the Code of State Regulations, and give us your comments on how we can improve them.
Comments can be submitted via multiple methods:
Web: DSS Rule Tracking Website Email: rules.comment@dss.mo.gov In Person: (see dates above)
For more information on the Governor’s initiative to cut government red tape, and to view upcoming public hearings or leave public comments for other state departments, visit NoMORedTape.com. If you have any questions about the public comment period, please contact Caleb Neeley at (573) 526-0414.
On September 8, 2016 the Federal Register posted the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. The regulation went into effect on November 16, 2016. The purpose of the rule is to ensure providers have adequate plans in place for natural and man-made disasters, and to promote coordination with federal, state, county, and local emergency preparedness systems.
The core elements of the rule include risk assessment and emergency planning, a communication plan, policies and procedures, and training.
Additional information may be found at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html and at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/EP-Rule-Table-Provider-Type.pdf
You can read the full text at https://www.federalregister.gov/documents/2016/09/16/2016-21404/medicare-and-medicaid-programs-emergency-preparedness-requirements-for-medicare-and-medicaid
Please contact Missouri Medicaid Audit and Compliance at MMAC.General@dss.mo.gov with any questions.
Current state and federal regulations (13 CSR 65-2 and 42 CFR 455.410) require ordering, prescribing or referring (OPR) providers to enroll with Medicaid, even if they do not accept Medicaid. In response, MO HealthNet has begun implementing changes in the claims processing system to deny all claims that require an order, prescription or referral from a physician or other licensed health care professional unless that physician or provider has an active enrollment record on file.
The Mo Healthnet Remittance Advices for Durable Medical Equipment (DME), Independent Laboratory medical claims, Imaging medical claims, and Home Health claims contain the following alert when the ordering, prescribing, or referring provider on the claim is not an actively enrolled provider:
N613 Alert: Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.In November 2017, the claims will begin to deny unless the ordering, prescribing, or referring provider information is on the claim, and the provider is enrolled with MO HealthNet.
In order to assist with this process, the Missouri Medicaid Audit and Compliance Unit (MMAC) provides an Ordering Prescribing and Referring Enrollment Application [OPR]
MMAC’s provider enrollment personnel will expedite all OPR applications received.
For more information, please choose “Providers” from the MMAC home page, and then choose “Provider Enrollment” and then choose “Ordering, Prescribing and Referring Enrollment Application [OPR]” providers.
Please submit any questions to MMAC.ProviderEnrollment@dss.mo.gov
Missouri Medicaid Audit and Compliance (MMAC), as part of the Department of Social Services (DSS) and in response to Governor Eric Greitens’ Executive Order 17-03, encourages public input on DSS’ Administrative Rules.
Please click here to view the dates, times, and locations for upcoming opportunities to comment on MMAC and other DSS rules. The link will also provide you with information regarding how to comment on the rules, on-line, instead of in person, if you wish.
Please contact MMAC at MMAC.General@dss.mo.gov with any questions.
Beginning January 1, 2018, according to federal regulation 42 CFR 438.602, states must screen and enroll, and periodically revalidate, all network providers of managed care organizations. This requirement applies to ordering, prescribing, and referring “OPR” providers in the managed care setting, as well.
This requirement does not cause managed care network providers to see Fee For Service Medicaid clients.
Missouri Medicaid Audit and Compliance (MMAC) is working with the MO HealthNet Division and the managed care health plans to provide a streamlined process for enrolling managed care network providers that have not yet enrolled with MO HealthNet.
Please submit any questions you may have to MMAC.ProviderEnrollment@dss.mo.gov
Missouri Medicaid Audit and Compliance (MMAC), as part of the Department of Social Services (DSS) and in response to Governor Eric Greitens’ Executive Order 17-03, encourages public input on DSS’ Administrative Rules.
Please view the News Release from DSS. The News Release contains information about DSS’ Administrative Rules, including where to view them, how to comment, and the time and location of public hearings.
Learn more about the Administrative Rules review at https://nomoredtape.com/
Please submit any questions to MMAC.General@dss.mo.gov
The Missouri Medicaid Audit and Compliance Unit (MMAC) enrolls MO HealthNet Fee for Service providers. Many providers utilize credentialing agencies to submit their enrollment paperwork and any subsequent updates. All enrollment approvals and updates are confirmed when MMAC sends an automated Approval Letter to the credentialing agency.
MMAC encourages the credentialing agencies to retain the approval letters. This will streamline efforts when the agencies wish to review their enrolled provider group and the corresponding dates of approval.
The Missouri Medicaid Audit and Compliance Unit (MMAC) encourages all enrolled MO HealthNet providers to keep their information up to date. Any changes can be reported to MMAC by using the Provider Update Request Form. Please click here to access the form. Please fax the form and any accompanying documents to 573-634-3105.
Questions? Please contact MMAC Provider Enrollment at MMAC.ProviderEnrollment@dss.mo.gov
The Spring session of Missouri Medicaid Audit and Compliance’s (MMAC) Annual Update Meetings for Home and Community Based providers is scheduled for April 18, 19, and 20, 2017. The meetings will be held in Rooms 490-492 at the Harry S. Truman Building in Jefferson City from 10:00 a.m. to 3:00 p.m. each day. Providers should plan to attend one day only (material is the same for each day and providers pick the day they wish to attend).
The content of the Spring Session will focus on In-Home Services (IHS) and Consumer-Directed Services (CDS).
Our Adult Day Center, Residential Care Facility, and Assisted Living Facility providers are all welcome to attend, but it is not required and the content will focus on IHS and CDS.
The Fall Session meetings are scheduled for October 24, 25, and 26, 2017.
