- How do providers and mental
health providers become part of the Missouri Care Health Plan provider network?
-
Where do providers send a claim?
-
Who do providers call with questions
about a claim payment or claim status?
-
How do providers order a current Provider Manual, Directory and/or Preferred Drug
List?
- How
do I find out who my provider representative is?
- If a member is pregnant and has been assigned
to a Primary Care Obstetrician (PCO), can she continue to see her regular Primary
Care Provider (PCP)?
- How do providers obtain authorizations from Missouri Care Health Plan?
-
How do providers verify enrollment
of a patient?
-
What services are covered by Missouri Care Health Plan?
- How can MC+ recipients switch to Missouri
Care Health Plan?
- Is a Prior Authorization
required for psychiatric consults for patients who are medically hospitalized?
1) How do providers
and mental 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
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.
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, option 3.
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.
A copy of the preferred drug list is included on this
Web site.
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.
6) If a member is pregnant and has
been assigned to a Primary Care Obstetrician (PCO), 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 PCO. The PCO 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
a PCO for her pregnancy.
7) How do providers obtain authorizations
from Missouri Care Health Plan?
Providers may contact the Prior-Authorization
Unit seven days per week, 24 hours per day by calling (800) 322-6027. Providers
may also fax requests for authorizations to Missouri Care Health Plan at (573) 441-2198.
For mental health services, providers may contact our Behavioral Health Care Managment
unit seven days per week, 24 hours per day by calling (800) 889-4073. Providers
may also fax requests for authorizations to Missouri Care Behavioral Health at (866)
543-2385.
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 to verify enrollment.
-
By calling the Interactive Voice Response at (800) 392-0938 (you must have your
9-digit provider Medicaid number to access this information). Refer to page 5 of
the Missouri Medicaid Professional Billing Booklet dated August 2001 for more information.
-
By setting up Internet access with the State
of Missouri Medicaid Web site at www.emomed.com.
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 the member handbook also included on this Web site.
10) How can MC+ recipients switch
to Missouri Care Health Plan?
MC+ recipients may only switch health plans
during open enrollment or in cases of medical necessity. Open enrollment dates and
additional information may be obtained by calling the MC+ Help Line at (800) 348-6627.
11) Is a Prior Authorization required
for psychiatric consults for patients who are medically hospitalized?
Prior Authorization is not required for inpatient
consults. However, we do require notification within 24 hours with a copy of the
completed consult.
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