Busting Myths About Being a Missouri Medicaid Provider


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n the last year, the Missouri Coalition of Oral Health* has been intention- ally collaborating with MO HealthNet, the MDA, and the State Department of


Health and Senior Services to increase access to care for all MO HealthNet participants — through increased provider enrollment. This collaboration will allow us to streamline our processes as well as provide resources and training to help providers be successful while they serve Missouri’s most vulnerable citi- zens. The goal of this article is to bust some common myths about Missouri Medicaid.


MYTH #1 As a Medicaid provider, I have to see all Medicaid patients in my area who are enrolled in Medicaid. FALSE: This is a busi- ness decision for each provider. Some choose to see only children and others may want to take only a certain number of MO HealthNet participants, thereby leaving room for exist- ing patients.


MYTH #2 The Medicaid rates are too low; I can’t afford to provide Medicaid. I will lose money. FALSE: Many of the covered proce- dures underwent a tremendous rate increase, to 80 percent of usual and customary fees. Some rates are even higher than some private insurance reimbursement. Find a link to the rates at modental.org/medicaid.


MYTH #3 It is too complicated to understand (and too many terms), like the difference between Managed Care verses Fee-For-Service. False: Providers often hear Managed Care (MC) and Fee-For-Service (FFS) when working with MO HealthNet. These terms are defined as: Managed Care (MC): In 2017, children, pregnant women, newborns and families were transitioned to the state’s three MC health plans (United HealthCare, Home State Health and HealthyBlue). The MC health plans are responsible for administering benefits and coverage on behalf of MO HealthNet to these populations. Note: A sub plan


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administered by Home State Health is Show Me Healthy Kids, specifically for instances of state custody, adoption subsidies and foster care. Fee-For-Service (FFS): The aged, blind, disabled and women with breast or cervical cancer remained in FFS. Providers will work with MO HealthNet directly when providing dental services to these individuals. If there are aspects like this that seem complicated, our team can help define and explain to help providers learn the lingo.


MYTH #4 The process seems difficult and there is no one to help walk me through be- coming a Medicaid provider. FALSE: We have real people, easily reachable, who want to help you! They are:


Jessica Emmerich, Dental Medicaid Facilitator | MO Coalition for Oral Health jemmerich@oralhealthmissouri.org 573-536-2474


Amanda Fahrendorf, Lead Education & Collaboration Manager | MO HealthNet amanda.fahrendorf@dss.mo.gov 573-751-6683


Jessica and Amanda can provide a wealth of information about MO HealthNet enroll- ment, Managed Care credentialing, and bill- ing and policy questions — and they can con- nect providers with training and resources.


MYTH #5 It can be a long process to be approved to be a Medicaid Provider and seem overwhelming; I feel I can’t do it on my own. FALSE: While it’s true enrollment and credentialing can feel like a bit of a pain point, as noted above, we’re here so you don’t have to go it alone! Just like taking any new insurance plan at your practice, all dentists who want to provide care to MO HealthNet participants must go through a process, including first enrolling with Missouri Medicaid Audit and Compliance (MMAC). The good news is that dental applications, if they are complete when submitted, are pro- cessed quickly and we can report that MMAC is currently processing dental applications within 10 to 14 days!


Providers must also enroll with each Man- aged Care (MC) company. MO HealthNet is working with the plans and MMAC to streamline this credentialing and enrollment process. There are specific contacts for dental providers to help with that process. Amanda or Jessica can provide those contacts to you.


Additionally, if you would like to start the MC enrollment process prior to receiving the final approval from MMAC, please reach out to Jessica or Amanda. They can contact the plan and request that they allow you to start the enrollment process while you wait for the MMAC application to be approved.


MYTH #6 The documentation to apply for Medicaid is too burdensome. FALSE: The documentation is very similar to other insurance companies. Provider Enrollment has created an Enrollment Guide to assist with the enrollment process. The guide outlines what documentation is required for each provider type and how to complete the Provider Enrollment Application. The Enrollment Guide includes information for all provider types, therefore dental providers should concentrate only on requirements for Clinics/Group or Dentist.


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