According to state regulation 13 CSR 65-2.020(1)(A), all persons are required to enroll with the Missouri Medicaid Audit and Compliance unit (MMAC) as a billing or performing provider in the MO HealthNet Program if the services or items they provide will be billed to the MO HealthNet Program. This requirement applies to all Individual and Organizational providers who are affiliated with PACE Organization.
Any Individual or Organizational PACE provider working for a PACE Organization must enroll with MMAC as a non-billing provider unless they are already enrolled with MMAC. Providers who are already enrolled with MMAC as a FFS, MCO, or OPR provider do not need to submit another application as an Individual or Organizational PACE Provider.
MMAC has created an enrollment packet for Individual and Organizational PACE providers to enroll with MO HealthNet as a non-billing provider. Contact the MO HealthNet Division at MHD.PACE@dss.mo.gov, if you are interested in enrolling to become a PACE Organization provider. Click here for the PACE provider Individual and Organizational applications.
Please submit any questions you may have to MHD.PACE@dss.mo.gov
Many pharmacists are currently interested in enrolling as individual MO HealthNet providers to bill MO HealthNet for prescriptions ordered by pharmacists, such as at-home COVID tests. Pharmacists interested in only Ordering, Prescribing, or Referring (OPR) services for MO HealthNet participants should enroll as OPR providers. Pharmacists interested in performing or billing for services rendered to MO HealthNet participants should enroll as Billing or Performing provider.
OPR Provider Enrollment:
Pharmacists interested in enrolling only to be the ordering, prescribing, or referring provider on claims, MO HealthNet recommends pharmacists enroll as OPR Providers.
Examples of items pharmacists can prescribe in Missouri are: COVID Tests and Nicotine Replacement Therapy Note: Providers who choose to enroll as “OPR only” providers cannot submit medical claims to MO HealthNet for payment of services rendered. If the provider wishes to be able to submit claims for payment, the provider must enroll with MO HealthNet as a billing or performing provider. Time to complete enrollment: 3 – 5 days after receipt of the completed enrollment packet Link to Application: https://mmac.mo.gov/wp-content/uploads/sites/11/2022/03/OPR-Application-2022.pdf Additional OPR Provider Information: https://mmac.mo.gov/providers/provider-enrollment/ordering-prescribing-referring-opr-providers/ Helpful Hints to complete OPR application: Pharmacists must have an individual NPI to enroll. Pharmacists who do not already have an individual NPI can request one at: https://nppes.cms.hhs.gov/#/ Section 3 of the application asks for non-physician specialty, pharmacists should indicate: Unlisted Non-Physician Practitioner Type Specify: Pharmacist (E5) Completed applications must: Individually faxed to Provider Enrollment @ 573-634-3105 or email to: mmac.providerenrollment@dss.mo.gov Have the original wet signature of the individual provider No bank account information is needed to complete the application
Billing or Performing Provider Enrollment:
Pharmacists interested in enrolling with MO HealthNet to perform and be reimbursed for clinical services in addition to being able to order, prescribe and refer for MO HealthNet participants. Current pharmacist clinical services include but are not limited to: Medication Therapy Management and administration of healthcare administered drugs.
Time to complete enrollment: 2 to 3 weeks after receipt of the completed enrollment packet Link to application and additional enrollment information:
https://mmac.mo.gov/providers/provider-enrollment/ Helpful Hints to complete Billing or Performing Provider application: Pharmacists must have an individual NPI to enroll. Pharmacists who do not already have an individual NPI can request one at: https://nppes.cms.hhs.gov/#/ Section 3 of the application asks for non-physician specialty pharmacists should indicate: Unlisted Non-Physician Practitioner Type Specify: Pharmacist (E5 When enrolling, providers need to complete electronic funds transfer information for payment Completed Applications with an original wet signature of the individual provider may be submitted by: Email: mmac.providerenrollment@dss.mo.gov Fax: 573-634-3105
