The Provider Enrollment Unit is responsible for enrolling new providers, maintaining provider records, and answering provider inquiries for all MO HealthNet provider types. The Provider Enrollment staff is authorized and required to determine when new provider numbers are issued or when a current provider number will be updated. After a MO HealthNet provider number has been issued it must be used with all transactions pertaining to MO HealthNet. If a separate provider number has been issued for different location/practices, the provider is responsible to ensure the appropriate provider number is used when billing.
Each provider application is reviewed and must go through the same audit process even though a provider number may already exist for the provider at another practice location.
Applications are processed in date order as received by the Provider Enrollment Unit. Applications that have been returned to the provider for additional information are not processed priority. Internet applications that have been denied due to improper submission or additional information not furnished must be resubmitted and are not processed priority.
Providers who are required to submit their application on paper must submit the original forms that were sent to them by mail. They cannot be copied or faxed. Please do not use highlighters or markers on any forms. If the forms do not meet the enrollment requirements they will be returned.
To improve provider contact with the Provider Enrollment Unit an E-mail address has been established. Providers will no longer get a busy signal and may contact the Provider Enrollment Unit at their convenience via E-mail at providerenrollment@dss.mo.gov. All E-mails will be answered, however, some take more time to research than others. If you send an E-mail make sure Provider Enrollment has access to respond and security is not blocked out. Please include a phone number and fax number in the event there is a problem responding.
MO HealthNet participants are required to obtain services from Missouri or bordering state providers. MO HealthNet will consider enrollment of an out of state provider if at least one of the following conditions is met:
If the participant is enrolled with a Missouri MC+ health plan on the date(s) of service provided, the provider must contact the MC+ health plan concerning the services. It is not necessary to enroll with MO HealthNet unless services are provided to participants who are not enrolled with a MC+ health plan and one of the conditions stated above is met.
Services that routinely require prior authorization or have other limitations will continue to require prior authorization and be subject to established limitation, policies, and procedures applicable to MO HealthNet programs.
Completing an enrollment application does not guarantee a provider number will be issued, and receiving or maintaining a provider number does not guarantee payment.
Several MO HealthNet provider applications are now available via the MoMed Web site and must be completed while on the Internet. This site contains applications and requirements for enrollment. Information for current providers is also available for those who may need to change an address or make other changes. Please read the instructions carefully.
America On Line (AOL) does not support this site. You must have the latest version of Netscape Navigator or Internet Explorer.
Before enrolling, click on the Provider Enrollment Information and Requirements for new applicants and existing providers link at the top of the page and review before reading the rest of the page. This link indicates the qualifications necessary to enroll and required attachments for each MO HealthNet provider type.
Click the button at the bottom of the page to proceed to the next page.
A new applicant or a currently enrolled provider who has had a change of ownership, click on NEW Provider Enrollment Applications and select your provider type from the drop down list. If you do not find your provider type in the drop down, select ALL OTHERS and you will be directed to E-mail your request for an application.
Please make sure you meet the requirements of the program before you begin to complete an on-line enrollment application or E-mail for an application.
The provider number is normally made effective the first day of the month the application is received by Provider Enrollment, unless it has been indicated on the application that the provider number needs to be backdated. The Provider Application Part 2, question number 14, was created for applicants to indicate the date of service, participant name, and DCN if the provider number needs to be backdated. Only one participant is required in this field.
The provider number cannot be backdated prior to the license issue date, date of certification, or a combination of both depending on the program.
If you receive your approval letter and the effective date is incorrect, you may E-mail the Provider Enrollment Unit for further assistance at providerenrollment@dss.mo.gov.
You are only permitted to save the first page as a DRAFT due to security. If you choose SAVE AS DRAFT make sure you print the page or take note of the PIN number. You will be required to enter the PIN number to retrieve the partial application.
No. The application must be submitted according to the instructions given on the enrollment site.
No. The Internet enrollment application may not be submitted with corrections, fields whited out, crossed out, or replaced in any manner. If you notice an error while on-line you may make corrections by using the go-back button to get to the field that needs correcting. If information was entered incorrectly and the application has already been finalized on-line and printed, a letter may be submitted with the application stating the incorrect information and the correct information. The letter must contain the original signature of the provider and be maintained by the provider the same as the enrollment application.
No. The faxed application goes directly to an Internet database. As a result, each complete application with its required attachments must be faxed in a single transmission. Multiple applications in one transmission will be denied and will not be processed priority when resubmitted.
Once an application is processed, an approval letter is sent via postal mail to the provider's physical address.
No. Prior to returning or denying an application, the "contact person" indicated on the application is contacted by E-mail or phone and given the opportunity to fax the information if the missing documentation is acceptable by fax. Applications that have been returned or denied due to lack of information, improper forms, etc., will not be processed priority when they are resubmitted.
The Application for Provider Direct Deposit form is available on the MO HealthNet Web site. The instructions are on page two. This form must be printed before it can be completed.
Each provider must complete their own Application for Provider Direct Deposit form and sign with an original signature. The original signed form must be submitted via postal mail. If an applicant is enrolling in direct deposit at the same time as submitting their enrollment forms for a provider number, the form may be submitted with the Internet enrollment application.
A new form is required to be completed each time a change is made in routing or account numbers or if direct deposit needs to be cancelled.
Direct deposit is now a requirement for all provider applicants except for providers who have their payment made to the State of Missouri, such as an employee of a Department of Mental Health facility.
Civil Rights compliance and information is located on the the Momed Web site. You can also access the Civil Rights page through the MHD home page. There is a link under the Provider Enrollment section.
No. Providers just need to review the compliance information and ensure they are in compliance; they are no longer required to submit the completed forms to Provider Enrollment. Civil Rights forms submitted to Provider Enrollment will be disregarded.
Civil Rights compliance and information is located on the Internet. From the MHD home page you can find a link under the Provider Enrollment section or you can click here to go directly to the civil rights page
MO HealthNet provider numbers are confidential per State Regulation 13 CSR 70-3.020 Title XIX Provider Enrollment. Provider numbers will not be released to anyone by phone, fax, electronically, or sent by postal mail to any address other than the provider address listed on the Provider Enrollment master file. It is the provider's responsibility to notify their billing agent, corporate office, etc. of all pertinent information regarding the provider number and billing instructions.
This information can be accessed through the MHD home page under the Provider Enrollment section, enrollment guide. Or you can click here to go directly to the enrollment guide page. The enrollment guide gives specific information regarding changes and many other issues. The Provider Enrollment Unit may also be notified by postal mail or by E-mail as follows:
Provider Enrollment UnitThe E-mail address is providerenrollment@dss.mo.gov.
It is the provider's responsibility to ensure that their provider number and/or Internet access is only given to authorized personnel. If access needs to be terminated for one or more individuals, the provider is responsible for contacting the Infocrossing Healthcare Services, Inc. help desk at 573 635 3559 for assistance.
09/01/07
