Benefit Matrix

The Benefit Matrix is a practical tool now linked from the MO HealthNet Division’s Provider Participation page. Once a provider navigates to the Provider Participation page, the Benefit Matrix may be found on the left side of the page in the General Information section, underneath the “MO HealthNet Guide — Puzzled by the Terminology?” link. The Benefit Matrix is an Excel spreadsheet that outlines the various benefits and limitations for each of the MO HealthNet programs, as well as cost-sharing, and co-pay amounts.

Participant Administrative Lock-In

Some MO HealthNet participants are restricted (or locked-in) to a provider or providers, such as a certain physician/clinic and/or pharmacy, where the participant can receive treatment or services. A provider checking patient eligibility is given the names and phone numbers of the lock-in providers. Payment of services for a locked-in participant cannot be made to other providers, except for emergency services or authorized referral services.

HIPPA - Related Code Lists

Providers continue to question the explanation of the codes shown on their claim confirmation report, as well as their remittance advices.

MO HealthNet no longer reports MO HealthNet-specific explanation of benefits and exception message codes on any type of remittance advice. As required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) national standards, administrative code sets, such as Claim Adjustment Reason Codes, Remittance Advice Remark Codes, and NCPDP Version 5.0 Reject Codes for Telecommunication Standard are used.

Double-Check Your Faxes

Please take a few minutes to double-check faxes you may send to the State. When faxes leave a location, they are “stamped” with a Calling-Station ID across the top of the fax by the receiving agency. This Calling-Station ID is programmed into the fax machine and tells the receiving agency the fax number of the sender.

Missouri Medicaid Audit and Compliance Notification to Providers

Update on Recovery Audit Contractor (RAC) and Medicaid Integrity Contractor (MIC) Activities.

Section 6411 of the Affordable Care Act, Expansion of Recovery Audit Contractor (RAC) Program, amends section 1902(a)(42) of the Social Security Act and requires states to contract with a RAC vendor and allows states to reimburse contractors who assist in the identification and recovery of improper payments. Missouri contracted with Cognosante, LLC in December, 2011 to serve as Missouri’s RAC.

When to Contact Wipro Provider Communications

Providers are encouraged to contact Wipro Provider Communications at (573) 751-2896 with inquiries, concerns or questions regarding proper claim filing, claims resolution and disposition, and participant eligibility questions and verification. Wipro Provider Communications is the provider’s first line of communication. When claims require further review, the provider’s claim will be forwarded to the appropriate section in MO HealthNet for assistance.

MO HealthNet Medicaid Program Webinars

The MO HealthNet Provider Education Unit schedules webinars on a quarterly basis for many of the MO HealthNet (Medicaid) programs. If a provider has registered for a MO HealthNet webinar and cannot attend for any reason, the webinar participant should contact MO HealthNet Provider Education and cancel their registration. Only 12 participants are allowed to register for each webinar and at times there is a waiting list. By notifying MO HealthNet of the cancellation, providers on the waiting list will be contacted and given the opportunity to register.

Using the Timely Filing Tab to Correct Claims

The Timely Filing Tab found on the MO HealthNet billing web portal can be used to document timely filing when a claim has been submitted and denied within the MO HealthNet timely filing guidelines {within twelve (12) months from the date of service or six (6) months from the date on the Medicare provider's notice of the allowed claim} and is being corrected and resubmitted within two years of the date of service by following the instructions below.

Log onto the MHD billing web portal(link is external)

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