Providers commonly are confused between “non-covered” and “non-allowable” services. The various provider manuals contain sections, which describe these services.
Generally, non-covered services are those that are not covered by MO HealthNet program, regardless of the participant’s medical eligibility (ME) code. Or the services are not a covered benefit based on the participant’s eligibility and ME code. There may be instances where a service or claim is denied stating that the service is not covered because the claim was incorrectly filed. In these instances, the provider must correct and resubmit the claim.
Non-allowable services are those MO HealthNet considers to be included in the provider’s reimbursement for another procedure/surgery and are not separately allowable, not billable to the participant nor are reimbursable by the MO HealthNet program in any other manner.
Please review the appropriate section in your Provider Manual for this important information. Questions regarding whether a service/procedure might be non-covered or non-allowable should be directed to the Provider Communications Unit at (573) 751-2896.