ENROLLMENT OF MANAGED CARE NETWORK PROVIDERS

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