MO HealthNet All Patient Refined Diagnosis Related Group (APR-DRG) Calculator Update
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MO HealthNet All Patient Refined Diagnosis Related Group (APR-DRG) Calculator Update
The MO HealthNet Division (MHD) has released a revised version of the APR-DRG calculator, effective December 3, 2025. This update applies to all hospitals submitting claims for inpatient services.
Updated Precertification Forms for BH Services and ABA
Updated Precertification Request Forms for Behavioral Health Services and Applied Behavior Analysis
Reminder of Prior Authorization Process for Residential Treatment and Treatment Foster Care
Reminder of Prior Authorization Process for Residential Treatment and Treatment Foster Care
The MO HealthNet Division would like to remind providers of the process for obtaining prior authorization for Residential Treatment and Treatment Foster Care (TFC), as outlined in the Provider Bulletin issued on September 21, 2
American Society of Addiction Medicine (ASAM) 4th Edition, Level of Care 4
American Society of Addiction Medicine (ASAM) 4th Edition, Level of Care 4
Effective December 1, 2025, psychiatric hospitals that meet the definition of an Institution for Mental Disease (IMD), subject to the terms of the 1115 SMI/SED/SUD waiver, must align with ASAM Criteria, 4th Edition, Level of Care 4, Medically Managed Intensive Inpatient Services.
Inpatient Certification Reconsideration Process
Inpatient Certification Reconsideration Process
An attending physician, hospital, or participant who disagrees with Conduent’s (MO HealthNet Division’s review authority) initial denial determination for an inpatient certification is entitled to reconsideration by Conduent. The reconsideration may be requested before or after the participant is discharged from the hospital.
Nursing Home Reimbursement: Beginning to End
Nursing Home Reimbursement: Beginning to End
The Family Support Division (FSD), Department of Health and Senior Services Central Office Medical Review Unit (DHSS COMRU), and the MO HealthNet Division (MHD) have collaborated to create a new resource for nursing facility providers. We are excited to announce, Nursing Home Reimbursement: Beginning to End.