Frequently Asked Questions
Q1. How do providers and Behavioral Health providers become part of the Missouri Care Health Plan provider network?
Q2. Where do providers send a claim?
Q3. Who do providers call with questions about a claim payment or claim status?
Q4. How do providers order a current Provider Manual, Directory and/or Preferred Drug List?
Q5. How do I find out who my provider representative is?
Q6. If a member is pregnant and has been assigned to an OB Provider, can she continue to see her regular Primary Care Provider (PCP)?
Q7. How do providers obtain authorizations from Missouri Care Health Plan?
Q8. How do providers verify enrollment of a patient?
Q9. What services are covered by Missouri Care Health Plan?
Q10. How can MO HealthNet Managed Care participants switch to Missouri Care Health Plan?
Q11. Will authorization of behavioral health services be based on units, sessions, visits or hours?
Q12. How do I know how many visits should be billed for behavioral health services?
1) How do providers and Behavioral Health providers become part of the Missouri Care Health Plan provider network?
Please contact our Provider Relations Department for an application.
Missouri Care Health Plan
2404 Forum Blvd.
Columbia, MO 65203
(800) 322-6027
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2) Where do providers send a claim?
Missouri Care Claims Submission
P.O. Box 61625
Phoenix, AZ 85082-1625
Resubmissions should be sent to the same address – marked as resubmissions on the envelope.
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3) Who do providers call with questions about a claim payment or claim status?
Providers should contact the Claim Inquiry/Claim Research Unit in our Claims Department
at (800) 322-6027.
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4) How do providers order a current Provider Manual, Directory and/or Preferred Drug List?
Providers may call the Provider Relations Department at (800) 322-6027, or contact their assigned provider representative. The Preferred Drug List is also included on this Web site.
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5) How do I find out who my provider representative is?
Missouri Care Health Plan assigns every network provider a representative. Provider representatives are in regular contact with providers and/or office staff. Providers may confirm the name and phone number of their provider representative by calling the Provider Relations Department at (800) 322-6027.
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6) If a member is pregnant and has been assigned to an OB Provider, can she continue to see her regular Primary Care Provider (PCP)?
Yes. The member may see her PCP for non-pregnancy related issues. However, if the member wishes, she may obtain all medical care from her OB Provider. The OB Provider may refer her to a specialist, if necessary. The member ID card will always have the PCP name printed on the card even though the member selects an OB Provider for her pregnancy.
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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 (800) 322-6027. You may also fax your medical authorization to (573) 441-2198. For pharmacy authorizations call (800) 322-6027. You may fax the pharmacy authorization form to (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 (800) 889-4073. Providers may also fax requests for behavioral health authorizations to Missouri Care Behavioral Health at (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:
- By contacting our Member Services Department at (800) 322-6027.
- By calling the Interactive Voice Response at (573) 635-8908 (you must have your 9-digit provider MO HealthNet number to access this information). Refer to page 1.3 of the MO HealthNet Professional Billing Book dated September 2007 for more information.
- By setting up Internet access with the MO HealthNet Web portal at www.emomed.com.
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9) What services are covered by Missouri Care Health Plan?
Please refer to the benefit summary page on this Web site for a brief description of covered benefits. For a more complete description of benefits, please refer to member handbook also included on this Web site.
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10) How can MO HealthNet Managed Care participants switch to Missouri Care Health Plan?
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 (800) 348-6627.
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11) Will authorization of behavioral health services be based on units, sessions, visits or hours?
Authorization of services is based on “units”.
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12) How do I know how many visits should be billed for behavioral health services?
The maximum number of units is based either on the CPT definition or, if there is no time indicated in the CPT, MO HealthNet has assigned a time limit. A description of the codes and unit limit may be found in Section 13.2 of the MO HealthNet Psychology/Counseling Billing Book.
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