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Electronic Visit Verification (EVV) Claims Validation: Key Updates for Providers

February 20th, 2026

Soft Launch – Common Trends

This Bulletin is intended to provide details regarding the soft launch of claims validation for EVV that was initiated on January 7, 2026. Refer to the Hot Tip posted December 17, 2025, and the Hot Tip posted January 27, 2026, for additional information on the launch.

A large number of claims have been considered for the matching process and the majority of them have contained all needed information to successfully match with visits in the EVV Aggregator Solution (EAS).

For those claims that do not have a corresponding visit in EAS, the following trends have been identified:

  • Claims are being submitted before the EVV vendor sends the visit to the EAS
  • EVV is not being used by the provider for each member for all required services
  • The provider’s EVV vendor is not sending visits to the EAS daily or at all
  • Visits in the EAS are not in a verified status

Remittance Advice (RA) Reasons for Receiving an Alert

Providers are encouraged to review their RA to assist in the identification of claims that would be denied following the hard launch. A generic alert (N363) is displayed on the RA during the soft launch period. N363 code means that “In the near future, we are implementing new policies/ procedures that would affect this determination.” If this code appears on the Remittance Advice (RA), it indicates a discrepancy between the claim and the EVV visit in EAS. Providers are required to log into the EAS system to verify the accuracy and completeness of visit records and to determine the cause of any mismatches.

The alert may be due to any of the following reasons:

  • Provider ID does not match: The Provider ID from the claim did not match a Provider ID in the aggregator solution
  • Participant DCN does not match: The Participant DCN from the claim did not match a Participant DCN in the identified provider’s EAS account
  • Unmatched Units: A visit was found for the given criteria, but the units in the EAS were less than the units on the claim
  • Visit not found for the procedure code and date range
    • A verified visit was not found in the EAS for the dates of service on the claim
    • A verified visit was not found for the procedure codes •Visit was not in a verified status

To prepare for the hard launch of claims validation, providers must be diligent in logging into the EAS frequently to verify accuracy and completeness of visits.

First Phase of Hard Launch

The first phase of the hard launch of claims validation is scheduled for April 1, 2026. At that time, claims submitted for services requiring EVV and authorized by the Department of Health and Senior Services, Division of Senior and Disability Services (DSDS) (provider types 26 and 28), with no matching visits in the EAS will be denied.

Note: The second and third phases of the hard launch will impact claims for services requiring EVV provided by Home Health Care Service providers (provider type 58) and Department of Mental Health, Division of Developmental Disabilities (DDD) (provider type 85). The timeline for these phases will be provided at a later date.

For information regarding the EVV claims validation process, visit the EVV website at https://mydss.mo.gov/mhd/evv. For questions, contact Ask.EVV@dss.mo.gov.

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Electronic Visit Verification (EVV) Claims Validation Soft Launch Follow-Up

January 27th, 2026

MO DSS implemented the soft launch of claims validation for electronic visit verification (EVV) on January 7, 2026.  The launch was successful, and MO DSS has started to analyze the rate of success for submitted claims. As a result of this analysis, the following reminders are offered.

The majority of the issues identified were related to lack of matching visits in the EVV Aggregator Solution (EAS).  This could be due to a number of things including but not limited to:

•    EVV is not being used by the provider
•    The provider’s EVV vendor is not sending visits to the EAS
•    Visits in the EAS are not in a verified status 
•    Claims are being submitted before the EVV vendor sends the visit to the EAS

In order to ensure claims will be paid following the launch of hard edits, providers should not submit a claim for a visit unless the visit is visible in the EAS and is in verified status.  Per 13 CSR 70-3.320(3) (G) EVV vendors must send data to the aggregator solution at a minimum of once daily for all dates that visit data is captured by their provider agencies. Submitting claims before the visit is visible and verified in the EAS will cause your claim to deny with no visit found due to the claim not finding a visit in the aggregator.

For information regarding the EVV claims validation process, visit the EVV website. 

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.

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Scam/Fraud Email Alert

December 10th, 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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.

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FROM THE DIRECTOR

December 30th, 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.

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MO HealthNet Providers: Call Us For FREE!

October 8th, 2024

The Mo HealthNet Provider Communications Unit assists providers with eligibility and coverage verification, enrollment status, annual review dates, questions regarding proper claim filing, claims resolution and disposition, billing errors, verifying check amounts, and more.

Providers are encouraged to communicate with Provider Communications using the Provider Communications Management tool in eMOMED. Providers may also call the Interactive Voice Response (IVR) system at (573) 751-2896.
Beginning today, providers can also call Provider Communications TOLL FREE at (833) 222-7916.  The caller must have the provider’s National Provider Identifier (NPI). The IVR system allows a MO HealthNet provider six options:

  • Press 1 for MO HealthNet Participant Eligibility
  • Press 2 for Check Amount Information
  • Press 3 for Claim Information
  • Press 4 for Provider Enrollment Status
  • Press 5 for MO HealthNet Participant Annual Review Dates
  • Press 6 to Speak to a Representative for Other Issues

For more information on the IVR system, review Section 3.3 of the General Sections Manual. For questions, contact MHD.Education@dss.mo.gov.

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PAYMENT ERROR RATE MEASUREMENT (PERM) AUDIT

November 20th, 2023

The Centers for Medicare & Medicaid Services (CMS), in partnership with the States, is measuring improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs under their Payment Error Rate Measurement (PERM) process.

 

CMS and its PERM contractors will be sending records requests directly to Missouri Medicaid/CHIP providers for claims billed during state fiscal year 2024. Additional information about the PERM program is addressed on the CMS PERM website (https://www.cms.gov/PERM). Refer to the “Providers” link on the website.

 

Federal regulations require that Medicaid/CHIP providers submit the medical record documentation to support claims for Medicaid/CHIP services to CMS upon request. Providing medical records for Medicaid/CHIP patients does not violate the Health Insurance Portability and Accountability Act (HIPAA). Patient authorization is not required to respond to this request. CMS and its contractors will comply with the Privacy Act federal regulations governing the sharing and transmission of Protected Health Information (PHI).

 

Questions regarding the PERM audit may also be directed to the State PERM representative Joyce Chandler at 573-751-7993 or please email MMAC.PERMAUDITS@DSS.MO.GOV.

 

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Family Care Safety Registry (FCSR) Fee Increase

May 1st, 2023

Family Care Safety Registry (FCSR) Fee Increase: 

 

Effective May 1, the FCSR registration fee will increase to $15.00 due to the Highway Patrol’s name-based criminal record search fee increasing to $15. The fee increase results from statute and is required by the Patrol. The registration and background screening system (BSEES) is being updated to charge the new fee for online registrations, along with a credit card processing fee of $0.55, for a total of $15.55. Click for more information about the FCSR.

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PRESCRIBING PROVIDER NPI REQUIREMENT

September 20th, 2018

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.

 

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DEADLINE FOR ENROLLMENT OF MANAGED CARE ORGANIZATION NETWORK PROVIDERS

September 13th, 2018

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

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TELEHEALTH PROVIDER BULLETIN

February 2nd, 2018

A Provider Bulletin on “Telehealth” is now available online at: https://dss.mo.gov/mhd/providers/pages/bulletins.htm 

For provider and policy issues regarding MHD Clinical Services Programs, including Pharmacy, The Missouri Rx Plan (MORx), Psychology, Exceptions, and Medical Precertifications, email MHD at: clinical.services@dss.mo.gov.

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