
Below is information regarding the NOP and Risk Screening process, provider reimbursement, prenatal billing information, and the postpartum screening and billing. For additional questions, contact MHD.NOP@dss.mo.gov.
NOP and Risk Screening Process
- Why is there a new process to report pregnancies to MO HealthNet and when did it start?
The MO HealthNet Division (MHD) partnered with the Managed Care health plans (Home State Health, Show Me Healthy Kids, Healthy Blue, and United Healthcare) to develop a universal NOP process to capture information about a MO HealthNet (Medicaid) participant’s pregnancy and risk factors. The process allows providers to notify MHD and the appropriate Managed Care health plan of the pregnancy and risk factors with one easy step, and to ensure that supports can be provided to participants as early as possible.
The new process began November 1, 2024.
- Where do providers find the presentation outlining the new process for NOP and Risk Screenings?
The presentation can be found on the MO HealthNet Division (MHD) website, on the provider Maternal and Infant Health page; Notification of Pregnancy and Risk Screening. The comprehensive presentation reviews the goals of the new process, the workflow, step-by-step instructions for entry into the NOP Portal, billing and reimbursement, desired outcomes from utilizing the new process, and resource and contact information.
Also on the page is a recording of a training from October 2024 on the process.
- Do providers have to complete the Notification of Pregnancy and Risk Screening pdf form?
The information collected on the Notification of Pregnancy and Risk Screening form should be entered in to the NOP Portal. The pdf form is to aid provider teams with collecting the information. The provider or their staff may also choose to enter the information directly into the NOP Portal.
- Should the provider wait until the participant’s first OB visit to complete the Notification of Pregnancy and Risk Screening?
No, the Notification of Pregnancy and Risk Screening should be completed and entered in the NOP Portal as soon as the provider learns the participant is pregnant, regardless of the reason for the visit.
- Should providers who are only administering the pregnancy test (i.e., independent laboratories, Local Public Health Agencies, Rural Health Clinics, Emergency Rooms), and not seeing participants for prenatal care, use the NOP Portal and bill for entry of the information?
Yes, this is part of the effort to prioritize early support and outreach to participants by the Managed Care health plans. The Notification of Pregnancy and Risk Screening should be completed and entered in the NOP Portal as soon as the provider learns the participant is pregnant, regardless of the reason for the visit.
- How does a provider keep a record of what was entered into the NOP Portal?
After entering the necessary information in to the NOP Portal, providers will have the opportunity to save or print a printer-friendly PDF of the information entered. This document includes the reported and known corresponding risk factors that are reported for the participant. It is recommended that it be saved in the patient’s chart.
- If a participant miscarries and becomes pregnant again in the same year, should the provider submit another NOP Screening into the NOP Portal?
Yes, providers may enter and bill for a maximum of three screenings per calendar year for each participant.
- How does a provider determine if a NOP and Risk Screening has already been submitted on the NOP Portal for their participant’s pregnancy?
After submission of the information in the NOP Portal, providers should save the PDF form on the last screen and add that document to the participant’s medical record. When records are requested by a provider for a new OB visit, the documentation should be part of the participant’s record. Although there is no way to check the NOP Portal to determine if a Screening has already been completed for a participant, providers may look up this information in the Managed Care health plans’ provider portals using the instructions below.
Home State Health: Access the Home State Health provider portal and click on the Assessments tab. If not listed under this tab, there has not been a screening submitted for the participant.
Healthy Blue: Access the Healthy Blue provider portal and click on the Assessments tab. If a NOP and Risk Screening has been submitted the information from the screening will be populated. If there is no information listed, a screening has not been submitted for the participant.
United Healthcare: Access the United Healthcare provider portal and click on Assessments. If not listed under this tab, there has not been a screening submitted for the participant.
- How should a provider enter a participant’s NOP and Risk Screening information into the NOP Portal if the participant’s MO HealthNet (MO Medicaid) application has not been approved yet?
Providers should use DCN 99999999 to enter the participant’s information into the NOP Portal.
- Should NOP and Risk Screenings be completed on individuals with Temporary MO HealthNet During Pregnancy (TEMP) coverage?
Yes. The number 99999999 may be entered in the DCN field, if DCN is not known at the time of entry.
- If the Managed Care health plan reaches out to the provider to coordinate the participant’s care management, what occurs if the provider that submitted the information into the NOP Portal is not providing the prenatal care?
The Managed Care health plan will prioritize outreach to providers caring for participants at moderate-to-high risk, based on the information entered in the NOP Portal. The Managed Care health plan can also identify the current provider by reviewing claims entered for the participant.
- Will providers need to print out their own Healthy Moms Healthy Babies rack cards to provide to participants?
Providers are welcome to print the rack cards themselves to distribute to participants. Representatives from each Managed Care health plan will also have the cards to distribute when they visit a provider’s office/facility. Providers may reach out to the Managed Care health plans for rack cards at the following contacts:
- Healthy Blue: SM_MODCMREF@HealthyBlueMO.com
- Home State Health/Show Me Healthy Kids: HSHPCareManagement@Centene.com
- United Healthcare: mo_clinops@uhc.com
The cards are not required but do provide important information to the participant.
- Will providers need to enter information regarding the participant’s delivery and postpartum in the Managed Care Portals if they were required to do so prior to this process?
Yes, the Managed Care health plans still have the same requirements regarding this information.
- Will providers doing prenatal case management using telehealth still be able to bill for providing the case management service?
Yes, excluding procedure code H1000 (no longer active), providers will still be able to bill for prenatal case management services as they do now.
NOP Reimbursement
- Are providers reimbursed for completing the NOP and Risk Screening?
Yes, providers are reimbursed $50.00 each for up to three Screenings per participant, per year. Two prenatal screenings may be reimbursed after billing for the entry in the NOP Portal. An additional Screening may be reimbursed postpartum; however, this Screening should be maintained in the participant’s medical record and does not need to be entered into the NOP Portal. Refer to the Postpartum Screening and Billing FAQs below.
- Will providers be reimbursed for entry of the screening into the NOP Portal if the participant has not been assigned a pregnancy Medical Eligibility (ME) code by the Family Support Division?
Yes, a pregnancy ME code is not required for reimbursement of the NOP screening into the NOP Portal.
- If a NOP and Risk Screening has already been submitted for a participant’s pregnancy by an entity other than their OB provider, and then the participant visits their OB provider, or begins seeing a new OB provider, and they complete and submit a Screening, will this be denied for reimbursement as a duplicate?
No, providers may bill for a maximum of three Screenings per calendar year. If a record transfer has been made for a participant, the provider may also verify if an NOP and Risk Screening form is present in the participant’s medical record. Although there is no way to check the NOP Portal to determine if a Screening has already been completed for a participant, providers may look up this information in the Managed Care health plans’ provider portals using the instructions below.
Home State Health: Access the Home State Health provider portal and click on the Assessments tab. If not listed under this tab, there has not been a screening submitted for the participant.
Healthy Blue: Access the Healthy Blue provider portal and click on the Assessments tab. If a NOP and Risk Screening has been submitted the information from the screening will be populated. If there is no information listed, a screening has not been submitted for the participant.
United Healthcare: Access the United Healthcare provider portaland click on Assessments. If not listed under this tab, there has not been a screening submitted for the participant.
- Should the provider complete the Notification of Pregnancy and Risk Screening if the participant has MO HealthNet (Medicaid) and a commercial insurance?
Yes, providers should complete the screening. Providers will receive the $50.00 reimbursement for completion of the information in the NOP Portal for the prenatal screening, and one postpartum screening, as long as the participant has MO HealthNet coverage, regardless of other insurance. Primary insurance must be billed prior to billing MO HealthNet.
NOP Billing
- Who can bill for entry of the NOP and Risk Screening into the NOP Portal?
The billing provider whose office did the Notification of Pregnancy and Risk Screening and submitted the information in the NOP Portal may bill and receive reimbursement.
- Does the provider need to enter the NOP and Risk Screening information into the NOP Portal prior to billing for prenatal visits?
Providers should enter the NOP information into the NOP Portal as soon as possible; however, it is not necessary to be on file before billing for prenatal visits.
- How will a provider bill for completing the entry in the NOP Portal?
Providers will continue to bill as they do now. For Fee-For-Service (traditional Medicaid) participants, billing should be through eMOMED. For participants in a MO HealthNet Managed Care health plan, providers should bill as they do now with the appropriate health plan.
The following codes are reimbursed at $50.00 for completion and entry into the NOP Portal:
Code Description G9919-TH* Positive comprehensive SDOH screening and provision of recommendations/referrals. G9920-TH Negative comprehensive SDOH screening (No risk factors reported) * Screening is positive if there is a diagnosis (DX) code associated with the risk factor findings. All known DX codes should be entered on the claim. Any code that is in the range of Z55 through Z65 will satisfy the positive screening requirement when billing code G9919-TH. Refer to the FAQ “How are the participant’s risk factors captured and reported to MO HealthNet and the Managed Care health plans?” below for more information on DX codes.
Providers may also bill and be reimbursed $50.00 for one postpartum screening. Postpartum screenings should not be entered into the NOP Portal. There must be a postpartum diagnosis on the claim; postpartum code Z39.2 should be listed as the primary.
- What should a provider list as the primary diagnosis code on a claim for reimbursement for entry in the NOP Portal for a prenatal Screening?
Prenatal screenings require a Gestational Age diagnosis (DX) code.
- For gestational age for weeks one through seven, the DX code should always be reported as Z3A01. For example, if the Screening was entered in the NOP Portal at four weeks gestational age, the primary diagnosis code would be Z3A01.
- For weeks 8 and up, the DX code should be reported as Z3Axx, with ‘xx’ being the estimated weeks gestational age. For example, if the Screening was entered in the NOP Portal at 13 weeks gestational age, the primary diagnosis code would be Z3A13.
- How are the participant’s risk factors captured and reported to MO HealthNet and the Managed Care health plans?
The following diagnosis (DX) codes from the Screening will be captured in the NOP Portal:
DX Codes Description DX Codes Z59.0
Description General concerns about housing DX Codes Z59.1
Description General concerns about housing DX Codes Z59.81 Description General concerns about housing DX Codes Z59.4 Description Lacks consistent access to nutritious food DX Codes Z59.82 Description Lacks reliable transportation to attend prenatal visits and other activities to support a healthy pregnancy DX Codes Z59.86 Description Concerns about being able to afford this pregnancy, including needed medications DX Codes Z59.87 Description Will need supplies to care for baby at home (crib, car seat, diapers, etc.) DX Codes Z60.8 Description Patient lacks a support system to help with the pregnancy and after delivery DX Codes Z63.0 Description Known concerns about domestic abuse (physical, emotional, sexual) DX Codes Z65.4 Description Known concerns related to crime or violence in the community The following do not have a diagnosis (DX) code but are also captured in the NOP Portal:
- At risk for sexually transmitted infections (HIV, syphilis, hepatitis, chlamydia, etc.) affecting maternal/fetal health
- Does the patient need legal assistance on any concern that may impact maternal/fetal health?
- If SUD is a concern, is the patient interested in treatment or recovery services?
- Is the patient currently working with a caseworker/social worker?
- Will providers still submit claims to the Managed Care health plans for completing a Screening, as well as submitting a claim for entry in the NOP Portal?
Providers should submit only one claim.
- Can the new codes for entry of the information in the NOP Portal be billed along with the participant’s visit?
Yes, the procedure codes G9919-TH and G9920-TH may be billed with other relevant procedure codes for the participant.
- Do the procedures codes for this process replace the previous H1000 code?
Procedure codes G9919-TH and G9920-TH replace the previous risk screening code, H1000.
- If the provider does not determine any risk factors during the NOP and Risk Screening, can the provider still bill for the Screening?
Yes, in this situation the provider would bill the Notification of Pregnancy and Risk Screening as G9920-TH (Negative comprehensive SDOH screening).
- If the provider does not determine any risk factors during the NOP and Risk Screening, what should they enter in the diagnosis field of the claim?
Providers should enter a gestational weeks code if it was during the prenatal period, or a postpartum code (usually Z39.2) if after delivery. No SDOH Z-codes would be entered.
Postpartum Screening and Billing
- Where do providers enter the information for the participant’s postpartum screening?
The NOP portal is only for notification of pregnancy. The postpartum Screening should not be entered into the NOP Portal. Any risk factors identified during the screening at the postpartum visit should be documented on the claim only by entering the correct diagnosis Z-codes.
- When completing the NOP and Risk Screening for a participant postpartum, what information should be entered for the gestational age and due date fields?
The NOP portal should only be used for the notification of pregnancy, not for entry of postpartum information. The screening should be documented in the medical record and risk factors should be communicated using the appropriate Z-codes. In place of a gestational weeks code, the postpartum code Z39.2 should be included.
- If a provider does not currently screen their participants postpartum, under this new process, do they have to start?
The MO HealthNet Division (MHD) requests that providers consider administering a postpartum Screening, billable to MHD with a $50 reimbursement, but it is not a requirement that providers do so. Providers may use standard risk factor tools often included in electronic health records (EHRs), the PRAPARE tool, or modify the same questions asked in the Social Risk section of the Notification of Pregnancy and Risk Screening to identify those priority risk factors in the postpartum period.
- Does the claim for completing the postpartum screening have to be submitted within a certain timeframe after the birth?
There is no timeframe for the claim to be reimbursed; however, the claim with the inclusion of the risk factors is the only way that this information is communicated so we encourage a timely submission.