Members
Q1. How do I contact the Missouri Care Member Services Department?
Q2. What is a Primary Care Provider (PCP)?
Q3. What if a specialist is needed?
Q4. How do providers order a current Provider Manual or Directory?
Q5. What if a Missouri Care Health Plan member needs medical advice in the middle of the night or while out of town?
Q6. Should Missouri Care Health Plan members go to the Emergency Room when their PCP isn’t available?
Q7. How do providers obtain authorizations from Missouri Care Health Plan?
Q8. How do providers verify enrollment of a patient?
Q9. What if Missouri Care Health Plan members lose their card?
Q10. How can MO HealthNet Managed Care participants change health plans?
Q11. I want to keep seeing my Behavioral Health provider; what do I need to do?
Q12. I need outpatient Behavioral Health treatment now. What should I do?
1. How do I contact the Missouri Care Member Services Department?
To contact the Member Services Department call (800) 322-6027. Other important phone numbers can be found at the Contact Us page on this Web site.
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2. What is a Primary Care Provider (PCP)?
At Missouri Care Health Plan, a Primary Care Provider (PCP) is the doctor, nurse or clinic in our network who will be the member’s main health care provider.
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3. What if a specialist is needed?
A PCP will make a referral to a specialist in our network.
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4. How do providers order a current Provider Manual or Directory?
Providers may call the Provider Relations Department at 1-800-322-6027, or contact their assigned provider representative.
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5. What if a Missouri Care Health Plan member needs medical advice in the middle of the night or while out of town?
Members should always call their PCPs first. The PCP will advise members on what to do. Members can also call Informed Health Line, our 24-hour advice line. Medical personnel are always available to answer health questions or to help with health problems. Their number is 1-800-556-1555.
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6. Should Missouri Care Health Plan members go to the Emergency Room when their PCP isn’t available?
In a true emergency, call 911 or go to the nearest emergency room. Emergency care is given for a medical emergency when a member believes his/her health is in serious danger – when every second counts. Examples of emergency situations include:
- Chest pain
- Stroke
- Difficulty breathing
- Bad burns
- Deep cuts
- Heavy bleeding
- Gunshot wounds
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7. How do providers obtain authorizations from Missouri Care Health Plan?
Providers may contact the Prior Authorization Department seven days per week, 24 hours per day. To obtain medical authorizations, call 1-800-322-6027. You may also fax your medical authorization to 1-866-946-2052.
For Behavioral Health services, providers may contact our Behavioral Health Care Management unit seven days per week, 24 hours per day by calling 1-800-889-4073. Providers may also fax requests for behavioral health authorizations to Missouri Care Behavioral Health at 1-866-543-2385.
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8. How do providers verify enrollment of a patient?
A provider may verify enrollment of a member several ways:
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By contacting our Member Services Department at 1-800-322-6027.
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By calling the Interactive Voice Response at 573-635-8908. You must have your 9-digit MO HealthNet provider number to access this information.
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By setting up Internet access with the MO HealthNet secured Web portal.
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9. What if Missouri Care Health Plan members lose their card?
Missouri Care Health Plan members can use the Contact Us page on our home page, or they can call our Member Services Department at 1-800-322-6027. A new card will be sent out right away. If members lose their MO HealthNet health insurance card, they should contact their local Family Support Division (FSD) office.
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10. How can MO HealthNet Managed Care participants change health plans?
MO HealthNet Managed Care participants may switch health plans during open enrollment or in cases of medical necessity. Open enrollment dates and additional information may be obtained by calling the MO HealthNet Help Line at 1-800-348-6627.
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11. I want to keep seeing my Behavioral Health provider; what do I need to do?
If your provider is contracted, or is in the process of contracting with us, you will be able to continue seeing your provider with no interruption in treatment. Your provider will need to contact us after they have seen you for 10 sessions for continued authorization.
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12. I need outpatient Behavioral Health treatment now. What should I do?
Locate a provider through the Web directory or call to make an appointment. Call Missouri Care at 1-800-889-4073 to request a list of contracted providers.
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