PROPER BILLING FOR DRUGS BILLED TO MO HEALTHNET

MO HealthNet Division (MHD) will begin desk audits of providers to ensure proper billing units are used for drugs billed to MO HealthNet. Providers are responsible for proper billing of claims as outlined in Section 15 of the Pharmacy Provider Manual (https://mydss.mo.gov/mhd/provider-manuals). Billing a claim with the incorrect unit of measure may result in greater compensation than entitled. Providers are reminded that they must have adequate documentation, as defined in 13 CSR 70.3.030(2)(A), from which services rendered and the amount of reimbursement received by a provider can be readily discerned and verified with reasonable accuracy. These records must be made available to MO HealthNet upon request.

For more information on what to expect during a desk audit please see here: https://mmac.mo.gov/wp-content/uploads/sites/11/2016/02/Audit-guidance.pdf.

MO HealthNet Division will host a series of webinars to aid providers in proper billing of drug claims to MO HealthNet. These webinars will allow for live questions and will be recorded for future reference. Click below to register.
If MO HealthNet providers have questions on proper billing of drug claims, contact PAU at 573-751-6963 or email MHD.PharmacyAdmin@dss.mo.gov.