Applications and Forms

Revalidating providers cannot use the electronic enrollment portal that is available for newly enrolling providers. Revalidating providers are required to complete specific paper forms and they must be submitted to MMAC directly by e-mail, fax, or regular mail. MMAC anticipates having an electronic portal for revalidations available in late 2015 or early 2016

Effective July 1, 2015, MMAC will begin revalidating all currently enrolled MO HealthNet providers. During the next two state fiscal years, MMAC will be concentrating on revalidating the approximately 20,000 currently enrolled physicians (MD and DO). Those physicians who have been enrolled with the Missouri Medicaid program the longest will be the first to receive revalidation packets.

During state FY-2018, MMAC will revalidate individual providers such as Dentists, Podiatrists, Advanced Practice Nurses and Licensed Professional Counselors.

Physicians who enrolled with MO HealthNet during 2012, 2013, or 2014; will       not receive revalidation notices until 2017, 2018, and 2019; respectively.

Currently enrolled physicians (MD and DO) with questions about revalidation should contact