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Enrollment of Managed Care Network Providers

Tuesday, October 10, 2017   (0 Comments)
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Enrollment of Managed Care Network Providers


Beginning January 1, 2018, according to federal regulation 42 CFR 438.602, states must screen and enroll, and periodically revalidate, all network providers of managed care organizations (MCOs).  This requirement applies to ordering, prescribing, and referring “OPR” providers in the managed care setting, as well.

This requirement does not cause managed care network providers to see Fee-For-Service (FFS) Medicaid clients.  Providers who are already enrolled with MO HealthNet as a FFS or OPR provider do not need to submit another application as a MCO Network Provider.

Missouri Medicaid Audit & Compliance has created two enrollment application forms for MCO network providers to enroll with MO HealthNet as a non-participating provider.  Click here for the individual physician or non-physician practitioner provider application and here for the organizational provider application.

MCO network providers may begin submitting their MO HealthNet applications to MMAC immediately.

Please submit any questions you may have to MMAC.ProviderEnrollment@dss.mo.gov


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