Skip to content

Industry News: Medicaid Missouri

Timely Filing Guidelines
Tuesday, January 31, 2012

• Original claims must be filed by the provider and received by the state agency within twelve (12) months from the date of service. Any claims that originally were submitted and received within twelve (12) months from the date of service, but were denied or returned to the provider, must be resubmitted and received within twenty-four (24) months of the date of service.

Loss of Medical or Billing Records Due to Natural Disaster
Monday, June 27, 2011

If you have medical or billing records that have been lost due to a natural disaster, an Attestation of Medical Record Loss or Destruction form should be filled out and kept in your records, in place of the records that have been lost. This form will serve as the replacement for all records lost or destroyed to the point in time of the loss or destruction. All records after the point in time of the disaster forward must be original records maintained as in the normal course of business, under the usual documentation rules.

Billing Claims for Tornado Victims
Monday, June 27, 2011

In a bulletin issued on January 20, 2006, titled ‘Instructions for Catastrophe/Disaster Related Claims’, providers were instructed to add a ‘CR’ modifier to professional claims and ‘DR’ Condition code to facility claims for disaster related claims. As a result, providers should use the modifier/condition code for all claims for participants affected by the Joplin, MO tornado disaster.

Medicaid Missouri accepts the 2011 versions of CPTand HCPCS code sets
Monday, January 31, 2011

Effective for dates of service on and after January 1, 2011, the MO HealthNet Division (MHD) will accept the 2011 versions of the Current Procedural Terminology (CPT) and the Health Care Procedure Coding System (HCPCS) medical code sets. Providers will not be able to bill the 2011 versions of the code sets until January 31, 2011 due to time requirements to complete system updates. Providers should reference the appendix of the CPT and HCPCS books for a summary of the additions, deletions and revisions.

Timely Filing Guidelines
Monday, January 31, 2011

MO HealthNet timely filing guidelines for claims and adjustments can be found in Section 4 of Provider Original claims must be filed by the provider and received by the state agency within twelve (12) months from the date of service. Any claims that originally were submitted and received within twelve (12) months from the date of service, but were denied or returned to the provider, must be resubmitted and received within twenty-four (24) months of the date of service.

Implementation of Revised Policies Related to Audit Look–Back Period and Provider Response Time for Documentation Requests
Monday, November 22, 2010

This informational bulletin is to notify you of two policies that CMS and the Medicaid Integrity Group (MIG), Program Integrity is implementing to improve the process whereby Audit Medicaid Integrity Contractors (Audit MICs) conduct audits of Medicaid providers. CMS has developed national standards for:

• Look-Back period for Audits—establishes the period of time to five (5) years prior to the start date of the audit, during which time providers claims will be subject to audit.

Direct Deposit Requirement and Elimination of Paper Remittance Advices
Wednesday, September 01, 2010

Direct Deposit Requirement

Effective November 1, 2010, MO HealthNet provider paper reimbursement checks will no longer be mailed. The last paper check mailed will be the one for the October 22, 2010 financial cycle (dated November 5, 2010). All providers who currently do not have direct deposit of their reimbursement checks must complete an Application for Provider Direct Deposit form to have their reimbursement directly deposited to their bank or savings account.

Elimination of Paper Remittance Advices