Administrative Lock-In Emergency Services Process
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 eMOMED when verifying eligibility.
Payment for outpatient hospital or physician services for a locked-in participant is only made to the authorized provider, unless the payment is for emergency services or authorized referral services.
Emergency services are only considered for payment if the claim is supported by medical records documenting the emergency circumstances.
When emergency services are administered to a locked-in participant the paper claim, with EMERGENCY noted at the top of the claim and medical records supporting the emergency room service must be submitted to:
Wipro Infocrossing
P.O. Box 5600
Jefferson City, MO 65102
When a physician is the designated/authorized provider, they are responsible for the participant’s primary care and for making necessary referrals to other providers as medically indicated.
When a referral is necessary, the authorized physician must complete a Medical Referral Form of Restricted Participant (PI-118). This referral is only good for 30 days from the date of service (DOS). This form must be submitted by the unauthorized provider via eMOMED or mailed to:
Wipro Infocrossing
P.O. Box 5900
Jefferson City, MO 65102
Refer to the General Sections Manual for more information regarding Administrative Participant Lock-In.
For other questions, contact Provider Communications via eMOMED, or by calling (833) 222-7916.