Complementary Health and Alternative Therapies for Chronic Pain Management: Pre-Certification Process and Billing
On April 1, 2019, the MO HealthNet Division (MHD) implemented statewide Complementary Health and Alternative Therapy Services for Chronic Pain Management.
The Complementary Health and Alternative Therapy Services program includes a combination of newly covered services: physical therapy, chiropractic therapy, and acupuncture, along with current coverage of cognitive-behavioral therapy (CBT) and non-opioid medication therapy.
Pre-certification of physical therapy, chiropractic therapy, and acupuncture services is a two-step process:
- The provider that prescribes the physical therapy, chiropractic, or acupuncture service must initiate the precertification process.
- The “performing provider” that will perform the service must access the precertification to complete the second step.
- If the performing provider is part of a clinic or facility, the group (billing) NPI must be used in step 2. The group (billing) NPI must be used to bill the claim as well.
- The individual performing provider NPI must be entered in performing provider field on eMOMED.
To obtain pre-certification, enrolled providers can call 800-392-8030, and choose Option 6, or use CyberAccess, a web tool that automates this process for MO HealthNet providers.
If you are not a CyberAccess user, contact the help desk at 888-581-9797 or 573-632-9797, or email cyberaccesshelpdesk@conduent.com to set up an account.
An approved pre-certification request does not guarantee payment. Providers must verify participant eligibility on the date of service by using the Interactive Voice Response (IVR) System at (573) 751-2896 or by utilizing eMOMED.
Providers that submit orders, prescriptions or referrals for Medicaid participants must have an active enrollment status with MO HealthNet in order for the billing provider’s claim to be approved. This is very important. All ordering, referring, or prescribing providers are required by state and federal regulation to be enrolled with MHD.
- For participants enrolled as members in a Managed Care health plan, providers will need to contact the member’s MO HealthNet Managed Care health plan directly for questions regarding their pre-certification procedures.
On January 1, 2020, MHD started covering chiropractic services for all MHD participants. These services are separate from the chiropractic services offered in the Complementary Health and Alternative Therapies for Chronic Pain Management program. See this bulletin for information about these chiropractic services.