MO HealthNet Division (MHD) will process claims in accordance with the established MHD coordination of benefits policy for Non-Qualified Medicare Beneficiary (Non-QMB) participants enrolled in a Medicare Advantage/Part C plan. Please refer to the policy in the MHD provider manuals, General Section 5 - Third Party Liability.
Some MO HealthNet participants are restricted or locked-in to authorized MO HealthNet providers of certain services to help the participant use the MO HealthNet program properly. When the participant has an administrative lock-in provider, the provider’s name and telephone number are identified on electronic billing website emomed or the IVR (Interactive Voice Response) system accessed from 573-751-2896, when verifying eligibility.
A provider wishing to submit claims or attachments electronically or access the Internet website on emomed must be enrolled as an electronic billing provider.
Providers wishing to enroll as an electronic billing provider may register online on emomed or contact the Wipro Infocrossing Help Desk at (573) 635-3559.
Providers are unable to access emomed without proper authorization. An authorization is required for each individual user.
MO HealthNet funds are used after all other potential resources available to pay for the medical service have been exhausted. Please refer to the provider manual General Section 5 – Third Party Liability (TPL).
Spenddown refers to the amount of medical expenses that are a participant’s financial responsibility, which is similar to an insurance deductible. Participants may choose to have the providers submit incurred medical expenses to the spenddown unit on behalf of the participant.
The “Bundled Value Code” field is a new field located on the electronic Medicare UB-04 Part A Institutional crossover claim form. When entering a claim in emomed, this field is located within the Header section of the online claim form. Providers may reference the Emomed Help button located on the upper right corner of the online claim form for definitions of the fields.
MO HealthNet Division (MHD) provides useful information for providers of all types, who participate in the MHD programs. Providers and their staff can find multiple links from the Provider Participation web page or links may be obtained from emomed, under the feature links section, Provider Information.
MO HealthNet Division (MHD) Provider Education Unit provides webinar-based trainings to enrolled providers. Please access the Webinar Training schedule to attend any training that pertains to the provider’s specific training needs. Provider Education representatives want to ensure providers are given the full allotted time to go over the listed claim(s) type that pertain to the Webinar.
Please access the Claims Processing Schedule for Fiscal Year 2015, for the updated claims processing schedule located on the MO HealthNet website.
Claims Processing and Payment Schedule for Fiscal Year 2015
Inquiries regarding proper claim filing, claim denials, Remittance Advices, and participant eligibility should be directed to the Provider Communications Unit at (573) 751-2896. The Provider Education Unit should be contacted for training and education on proper billing methods and procedures for MO HealthNet Claims.
