Eligibility verification is essential to processing a claim for reimbursement. Providers shall check participant eligibility on the date of service (DOS) to verify the participant’s eligibility status and covered services.
There are many reasons to check eligibility, such as name and MO HealthNet identification number match, eligibility verification on DOS, reference to medical eligibility (ME) plan code, benefits and limitations, additional payer information, administrative lock-in provider information, spenddown amount and Qualified Medicare Beneficiary (QMB) versus non-QMB identifiers.
MO HealthNet has created an audio/visual training PowerPoint presentation titled Determining Eligibility. Providers can utilize this tool as a guideline for staff to better understand the online eMOMED participant eligibility screens. This audio/visual tool is available electronically from the Provider Participation page.
In addition to checking MO HealthNet participant eligibility through eMOMED, providers may also verify eligibility by contacting Provider Communications at 573-751-2896.