Medicaid (MO HealthNet)
The MDA encourages dental providers to sign up for MO HealthNet News to receive emails directly from MO HealthNet (all bulletins, Hot Tips and other emails are sent through this distribution list). Providers will receive information about ALL MO HealthNet programs, but notifications will clearly state the program (such as dental) impacted by the change or update. Signup by visiting the website and completing the pop-up request OR provide your email under Email Updates on the right side of the page.
If you have additional questions, email Amanda Fahrendorf with MO HealthNet Education and Training Unit or call 573-751-0352. Additional resources can be found on the MO HealthNet Provider Page.
Other Helpful Links
New Medicaid Rates Paying As of October 28, 2022
MO HealthNet has loaded the new rates in the system! This means claims entered starting October 28, 2022 will pay at the higher rate. MO HealthNet will send out a bulletin regarding reprocessing claims back to July 1, 2022. Do not reprocess your claims; MO HealthNet will do a mass adjustment!
Education & Training
Provider Training Calendar (find/register for Dental sessions)
Tuesday, October 11, 9-11am (Dental Billing) Register
Tuesday, December 13, 9-11am (Dental Billing) Register
Medicaid Information Series
Read Medicaid articles from the MDA to stay informed. Click link below.
There's a Rate Increase, Now What
- Managed Care Vs Fee-For-Service & Why The Difference Is Important
- Becoming A Medicaid Provider
- If I Enroll As A Provider, Do I Have To Accept All Patients In My Area Who Are Enrolled In Medicaid?
- What Documentation & Info Do I Need For MMAC Enrollment?
- How Long Will It Take To Enroll With MMAC /Managed Care Plans?
MO HealthNet Information
Types of Coverage: Fee-For-Service (FFS) & Managed Care (MC)
Participants can be enrolled in a FFS or MC plan based on how they qualify for MO HealthNet (Missouri Medicaid). Providers will need to follow the billing, policy and prior-authorization guidelines of the plan the participant is enrolled in. Providers must bill MO HealthNet directly for FFS participants and the MC plan for patients enrolled in MC.
- MO HealthNet Fee-For-Service (FFS) participants: Individuals with disabilities, seniors, blind and visually impaired, or women with breast or cervical cancer.
- Missouri Managed Care (MC) participants: MO HealthNet for Families, MO HealthNet for Kids, MO HealthNet for Pregnant Women, Uninsured Women, Transitional MO HealthNet, children in care and custody of the state, children receiving adoption subsidy and Children’s Health Insurance Program (CHIP). Click here for General MO HealthNet Managed Care information. Following are the four Managed Care health plans and their dental subcontractors:
A sub plan administered by Home State Health is Show Me Healthy Kids (877-236-1020), specifically for instances of state custody, adoption subsidies and foster care.
All providers who want to treat MO HealthNet FFS or MC participants must first enroll with Missouri Medicaid Audit and Compliance (MMAC), which facilitates the MO HealthNet enrollment process.
Once the provider enrolls with MO HealthNet through MMAC, they will need to contact the MC plan they want to credential with. Each plan has its own credentialing process.
Those who participate in the MO HealthNet program agree to accept the MO HealthNet payment as reimbursement in full for all covered services. A participant cannot be billed for the difference between the MO HealthNet and the provider's billed charges.
MO HealthNet MC services are provided in accordance with the terms and conditions of the contract between MO HealthNet and the MC health plans. Participants enrolled in MO HealthNet MC plans access services through the health plan's provider network.
Questions regarding MMAC’s enrollment process should be direct to: MMAC.email@example.com.