5 Easy Tips to Keep MO HealthNet (Medicaid) Claims from Denying
✅ Step 1: Check Eligibility First
Before rendering any services, verify the MO HealthNet participant’s eligibility. This help prevent denials due to inactive coverage.
To verify eligibility, visit eMOMED and click ‘Participant Eligibility,’ or call Provider Communications at (833) 222-7916.
Have ready:
- Participant’s MO HealthNet ID (DCN) or Social Security Number
- First and last name
- Date of birth
🔍 Step 2: Know the Medicaid Eligibility (ME) Codes
Not all ME Codes offer the same benefits. Some ME Codes have restrictions, and billing non-covered services will result in denied claims.
After verifying eligibility, carefully review the participant’s coverage details. Knowing coverage in advance helps you guide participant’s care confidently.
Visit ME Codes or the General Sections Manual for more information.
📝 Step 3: Check Prior Authorization Requirement
Some services require prior authorization. Without prior authorization approval, claims will be denied.
Before the appointment, confirm whether the service requires authorization and ensure approval has been received.
If the participant has commercial insurance, Medicare Part C without Qualified Medicare Beneficiary (QMB), or Medicare Part B or Part C with QMB does not cover the service, providers must continue to meet all MO HealthNet program requirements, including obtaining prior authorization, pre-certification, and other guidelines for these circumstances.
Be sure to review current MO HealthNet Provider Manuals and MO HealthNet News regularly, as authorization requirements may change.
🧾 Step 4: Bill the Participant’s Primary Insurance First
If a participant has both primary insurance and MO HealthNet, primary insurance must be billed first. Skipping this step will result in denial.
Always verify insurance coverage and submit claims to the primary payer before billing MO HealthNet as secondary.
Refer to the General Sections Manual for more information on Third Party Liability.
⏰ Step 5: Timely Filing
MO HealthNet Fee-For-Service: Claims must be filed within 12 months of the date of service.
Managed Care health plans: This varies by health plan. Providers should contact Managed Care health plans for additional guidance.
If filing deadlines are missed, claims will be denied. For more information on timely filing requirements, refer to eMOMED or the General Sections Manual.
For questions, contact Provider Communications via eMOMED or call (833) 222-7916. For additional information and training, visit MO HealthNet Education and Training.