1. Kim Morgan Provider Education MO HealthNet Division (MHD)
MO HealthNet Division (MHD) Q and A for Missouri Family Health Council August 12, 2016

2. MHD Policy

3. Provider Manuals Provider Manual Webpage:
Physician Manual:
Hospital Manual:

4. Provider Bulletins and Hot Tips
Provider Bulletin Webpage:
Hot Tips Webpage:

5. Women’s Health Services Program Bulletin February 19, 2016
Effective January 1, 2016
Provide coverage when primary diagnosis is related to Sexually Transmitted Infection (STI)
Services covered – family planning, family planning-related and supplies, and testing and treatment of STI diseases
Attachment:
A – listing of procedure codes
B – listing of covered diagnosis codes
See bulletin for further details

6. Sterilizations Consent Form, Section 10.2.E(1), Physician Manual
Procedure codes require Sterilization Consent Form be completed and submitted with claim: 55250, 58565, 58600, 58605, 58611, 58615, , and 58671
Form must be completed and signed by the participant at least 31 days, but not more than 180 days, prior to the date of the sterilization procedure
Must be 30 days between the date of signing and the surgery date (day after the signing is considered the first day when counting the 30 days)
Reference: Physician Manual, Section 10.E

7. Provider Communications Unit (PCU) (573) 751-2896 Email via MHD Web portal https://www.emomed.com
Providers’ Initial Contact!
Providers should contact PCU regarding concerns or questions about proper claim filing, claims resolution and disposition, and participant eligibility questions and verification
Provider Communications Unit
PO Box 5500
Jefferson City, MO

8. Pharmacy & Clinical Services
(573) or
Policy development, benefit design, coverage decisions, provider and program policy inquiries
Provider Education
Inquiries regarding education, training assistance and scheduling
Register for Training Today!

9. Claim Adjustments & Resubmissions
Provider Manuals
Section 6
Void Claim - ONLY used when the claim paid and should never have been billed; no need for a replacement claim to resubmit
Choose “Void” tab to bring up paid claim, scroll to the bottom of the claim and click on the highlighted “submit claim” button. The claim has now been submitted to be voided or credited in the system

10. Adjustments & Resubmissions
Replacement Claim – used when a claim paid but was billed incorrectly
Choose “Replacement” tab to bring up paid claim, select “edit” button to make changes, then save the changes. Scroll to the bottom of the claim and click highlighted “submit” button. The replacement claim has now been submitted

11. Adjustments & Resubmissions
Copy Claim - Original– used when a claim or any line of a claim denied that needs to be corrected. This will copy a claim just as it was entered
Choose “Copy Claim” tab to bring up claim, choose “original,” select “edit” button to make changes, then save the changes. Scroll to the bottom of the claim and click highlighted “submit” button. The corrected claim has now been submitted

12. Adjustments & Resubmissions
Copy Claim - Advanced– used when a claim denied that had been filed using the wrong NPI or wrong claim form
Choose “Copy Claim” tab to bring up claim, choose “advanced,” select “edit” button to edit NPI, then save the changes. Scroll to the bottom of the claim and click highlighted “submit” button
If claim was filed on wrong form, only DCN and Name will transfer to correct form. Key in claim and click “submit” button

13. CyberAccess Account setup or technical questions
CyberAccess web address:
CyberAccess helpful Tips:

14. Pre-Certification for services
CyberAccess
MHD participant claim data - procedures, diagnosis codes, and prescription information
Pre-Certification for services
Radiology, Durable Medical Equipment, Optical, Inpatient
Drug Prior Authorization (PA) or Clinical Edit Override (EO)

15. CyberAccess

16. MO HealthNet Division Website Provider Participation Page http://dss