State and federal regulations (13 CSR 65-2 and 42 CFR 455.432) require pre-enrollment and post-enrollment site visits of providers who are designated as “moderate” or “high” categorical risks to the Medicaid program. The purpose of the site visits is to verify the information submitted to MMAC is accurate and to determine compliance with federal and state enrollment requirements.
Effective July 1, 2015, MMAC will begin conducting pre-enrollment and post-enrollment site visits of new, reenrolling or revalidating “moderate” and “high” risk providers. Click here to see the risk category assigned to each Medicaid provider type in Missouri.
MMAC will attempt to accommodate all requests from other state Medicaid programs needing a pre-enrollment or post-enrollment site visit to be conducted in Missouri. If you are a provider who is attempting to enroll in another state’s Medicaid program and are advised you will need a site visit, please ask that state to contact the MMAC Provider Enrollment Manager at MMAC.ProviderEnrollment@dss.mo.gov. If you are an out of state provider attempting to enroll with Medicaid in Missouri and require a pre-enrollment site visit before you can be enrolled, MMAC will request that the Provider Enrollment unit in your state conduct the site visit on MMAC’s behalf.
Any moderate or high risk providers who received a site visit through Medicare or another state Medicaid agency in the last two years will not need a site visit to be conducted by MMAC prior to enrollment.