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Missouri Medicaid Provider Agreement

16. MEDICARE NUMBER: (if applicable) Enter the Medicare number or numbers assigned to the applicant provider`s physical location address and listed in fields 4-8. This information allows Medicare claims to automatically cross paths with Missouri MO HealthNet. Add a copy of Medicare`s letter that states the Medicare number, the provider`s name and the physical location authorized by Medicare (a postal or payment address is not acceptable). If the initial letter cannot be indicated, contact Medicare to request written documents to submit. If the Medicare number covers more than one office, fill out the forms with the physical location address to which the Medicare number is issued. If there are separate Medicare numbers for different sites, each site must register with MO HealthNet, as at Medicare. It is the supplier`s responsibility to submit claims for all Medicare/MO HealthNet claims that, for whatever reason, do not go electronically. When the clinic receives a “Medicare clinic or group number” (i.e. 000012345), each person also receives a number as a member of the clinic, in which case the clinic must register for Medicare/MO HealthNet claims to be automatically exceeded. The Medicare affirms the crossover and payment within the clinic MO HealthNet record provider. Execution providers are not screened during this process, a list of all members must be submitted and all clinic members must be registered with MO HealthNet, or no registration from the Mo HealthNet provider is established for the clinic.

If the clinic registers but each member is not registered and the Medicare/MO HealthNet clinic receives a payment for unregistered members of the clinic, this is considered a MO HealthNet fraud. If physicians, advanced nurse practitioners, NRCs or podiatrists refuse to register as top-performing providers and MO HealthNet pays Medicare fees that are automatically cross-referenced, it is considered fraud. MO HealthNet claims must be billed using the clinic`s name and provider number as a billing provider and the individual physician, Advanced Practice Nurse, cRNA, podiatrists and diabetes self-management as an execution provider. After their first re-validation or registration, MO HealthNet providers, who are not also Medicare providers, will re-validate before their registration expires in accordance with this rule. New providers whose applications are available on the internet must enter into the Electronic Funds Transfer (EE) authorization agreement in the online application. These apps have a separate signature page covering the entire app. Registration documents must be submitted at the following address: mmac.mo.gov/providers/provider-enrollment/home-and-community-based-services/adhc-proposal-packet/ applicants for adjacent CDE, LD or RPh must be authorized by their state and/or certified by the certification bodies mentioned above.