 May 03, 2024 Bulletins Ordering, Prescribing, Referring Provider (OPR) Requirements for School-Based Individualized Education Plan (IEP) Direct Services Program Applies to: School-Based IEP Direct Services Program Effective date: July 1, 2024 - Ordering, Prescribing, Referring Provider (OPR) Requirements for School-Based IEP Direct Service Program
- Provider Enrollment Requirements
- Performing Provider Requirement for School-Based IEP Direct Services
OPR Requirements for School-Based IEP Direct Service Program Effective for dates of service on and after July 1, 2024, claims submitted for MO HealthNet school-based IEP speech therapy, physical therapy, occupational therapy, and private duty nursing services must include the National Provider Identifier (NPI) of the OPR provider, and the OPR provider must be enrolled as a MO HealthNet provider. Claims for speech therapy services must include the referring provider's NPI, and claims for physical therapy, occupational therapy, and private duty nursing must include the ordering provider's NPI. When the licensed physical, occupational or speech therapist provides services without an order or referral from another prescriber in accordance with their scope of practice, the therapist is considered the ordering or referring provider. In these situations, the MO HealthNet enrolled therapist's NPI number must be included on the claim as the ordering provider for physical and occupational therapy services or the referring provider for speech therapy services. The individualized education plan (IEP) must be kept in the therapist's records and signed by the therapist. These requirements are in accordance with state regulation 13 CSR 65-2 and federal regulations 42 CFR 455.410 and 42 CFR 455.440. . Read more...
Hot Tips MO Medicaid Audit & Compliance New Toll-Free Number Missouri Medicaid Audit and Compliance (MMAC) is responsible for administering and managing MO HealthNet audit and compliance initiatives and managing and administering provider enrollment contracts for the MO HealthNet Division. MMAC has established a new toll-free number for providers: (833) 818-1183. For more information about MMAC, review the MMAC website.
Outpatient Observation Billing Outpatient hospital services are those services provided to a person who has not been admitted by the hospital as an inpatient but is registered on the hospital records as an outpatient and receives services from the hospital. Charges for observation time must be submitted on a CMS-1450 (UB-04) claim form via eMOMED using revenue code 0762 with procedure code G0378 and the actual number of hours the participant was in observation as units billed. Hospitals should round to the nearest hour. Observation time ends when all medically necessary services related to observation care are completed. Observation care may end prior to discharge if other medically necessary services do not meet the definition of observation care or when the patient is admitted inpatient or discharged. Do not include the time participants remain in the hospital after treatment has finished in the observation time when submitting the claim. Read more...
Physicians & Clinics Billing and Policy Workshop for MHD Providers MO HealthNet Education and Training is hosting an in-person Physicians & Clinics Billing and Policy Workshop in Jefferson City. Providers and staff that work for Physicians, Clinics, Chiropractors, FQHCs, Local Public Health Departments, and Rural Health Clinics will have the opportunity to participate in an interactive presentation with all three Managed Care Health Plans, Missouri Medicaid Audit and Compliance, and the MO HealthNet Division (MHD) regarding billing practices, policy, investigations and audits, and available resources. Review the workshop agenda for more information. There are 60 available seats for this event, be sure to register soon. When: June 3, 2024
Where: Governor Office Building, 200 Madison Street, Jefferson City MO
Time: 9am – 3pm
Pharmacy Preferred Drug List & Utilization Management Edit Update MO HealthNet is required to complete an annual review of all drug coverage criteria per 13 CSR 70-20.200 Drug Prior Authorization Process. Web page: https://mydss.mo.gov/mhd/pharmacy-clinical-edits-pdl Existing Edit update as of 05/02/2024: New Edit as of 05/02/2024: Hypoxia-Inducible Factor Prolyl Hydroxylase (HIF-PH) Stabilizers Clinical Edit
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