Retrospective Inpatient Certification Due to Incarceration

Retrospective Inpatient Certification Due to Incarceration

The MO HealthNet Division (MHD) requires all MO HealthNet enrolled hospitals in Missouri and bordering states to receive an admission certification. Retrospective (post-discharge) certification requests are only accepted when the participant has retroactive eligibility, or the hospital provider has a retroactive enrollment date. All other retrospective certifications will only be accepted on a case-by-case basis.

Group Prenatal Care Webinar

Group Prenatal Care Billing Webinar

The MO HealthNet Division (MHD) and the St. Louis Integrated Health Network held a jointly sponsored event to launch Group Prenatal Care on January 12, 2024. As a follow up to this exciting launch, MHD will be hosting a webinar on February 1, 2024. The webinar will include a video of the launch event and its dynamic speakers, as well as an interactive discussion regarding how to bill for Group Prenatal Care and other questions providers may have on this benefit.

Inhalers Update

Inhaler Update 

Effective for dates of service on and after January 15, 2024, MO HealthNet will no longer allow an exception to the Take Home Drugs and Supplies policy for hospital and clinic providers to bill for an inhaler if the participant is diagnosed with COVID or the participant has been exposed to COVID-19.

Ground Emergency Medical Transportation (GEMT)

Entities enrolled as MO HealthNet Ambulance program providers, who are owned or operated by the state or a political subdivision, and provide Ground Emergency Medical Transportation services to MO HealthNet participants may qualify for the Ground Emergency Medical Transportation (GEMT) program. For more information please visit the Ground Emergency Medical Transportation (GEMT) website to see if you qualify.

Re-Pricing Medicare Inpatient Hospital Claims

Since July 1, 1991, the MO HealthNet Division (MHD) has been re-pricing Medicare Part A inpatient hospital crossover claims for the possible payment of Medicare deductible and co-insurance amounts. This Hot Tip is a reminder that the re-pricing policy also applies to Medicare Part C/Advantage plans for inpatient hospital services for deductible, co-insurance and co-pay amounts for participants who are QMB eligible.

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