Internet Billing Application
Internet Billing Application
Internet Instructions
Internet Instructions
Trading Partner Agreement
Trading Partner Agreement
Adjustments
Adjustments
Advanced Health Care Directives
Advanced Health Care Directives
Claim Attachment Submission and Processing
Claim Attachment Submission and Processing
Claims Disposition
Claims Disposition
Exception Process
Exception Process
Family Planning
Family Planning
Healthy Children and Youth Program
Healthy Children and Youth Program
Managed Health Care Delivery System
Managed Health Care Delivery System
Medical Necessity
Medical Necessity
Medicare/MO HealthNet Crossover Claims
Medicare/MO HealthNet Crossover Claims
Non-Emergency Medical Transportation (NEMT)
Non-Emergency Medical Transportation (NEMT)
Prior Authorization
Prior Authorization
Provider and Recipient Services
Provider and Recipient Services
Provider Conditions of Participation
Provider Conditions of Participation
Recipient Conditions of Participation
Recipient Conditions of Participation
Third Party Liability
Third Party Liability
Timely Filing
Timely Filing
Claims Processing Schedule 2006
Claims Processing Schedule 2006
Claims Processing Schedule 2007
Claims Processing Schedule 2007
MO HealthNet Division Homepage
MO HealthNet Division Homepage
Fee Schedules
Fee Schedules
MO HealthNet Electronic Billing Layout Manuals
MO HealthNet Electronic Billing Layout Manuals
MO HealthNet Instructions and Applications
MO HealthNet Instructions and Applications
MO HealthNet Provider Manuals
MO HealthNet Provider Manuals
Provider Bulletins
Provider Bulletins
State of Missouri MO HealthNet Division Address
State of Missouri MO HealthNet Division Address
Benefits and Limitation
Benefits and Limitation
Billing Instructions
Billing Instructions
Diagnosis Codes
Diagnosis Codes
General Sections (All Providers)
General Sections (All Providers)
Procedure Codes
Procedure Codes
Reimbursement Methodology
Reimbursement Methodology
Special Documentation Requirements
Special Documentation Requirements
Adult Day Health Care
Adult Day Health Care
Aged and Disabled Waiver
Aged and Disabled Waiver
AIDS Waiver
AIDS Waiver
Ambulance
Ambulance
Ambulatory Surgical Center
Ambulatory Surgical Center
Community Psych Rehab
Community Psych Rehab
Comprehensive Day Rehab
Comprehensive Day Rehab
CSTAR
CSTAR
Dental
Dental
Durable Medical Equipment
Durable Medical Equipment
Environmental Lead Assessment
Environmental Lead Assessment
Hearing Aid
Hearing Aid
Home Health
Home Health
Hospice
Hospice
Hospital
Hospital
MRDD Waiver
MRDD Waiver
Nurse Midwife
Nurse Midwife
Nursing Home
Nursing Home
Optical
Optical
Personal Care
Personal Care
Pharmacy
Pharmacy
Physical Disabilities Waiver (Addendum)
Physical Disabilities Waiver (Addendum)
Physician
Physician
Private Duty Nursing
Private Duty Nursing
Behavioral Health Services
Behavioral Health Services
Rehabilitation Center
Rehabilitation Center
Rural Health Clinic-Independent
Rural Health Clinic-Independent
Rural Health Clinic-Provider
Rural Health Clinic-Provider
School District
School District
Services
Services
Therapy
Therapy
Transplant (Addendum)
Transplant (Addendum)
A - M
A - M
N - Z
N - Z
Approval Notice [IM-32]
Approval Notice [IM-32]
IM-32-MAF
IM-32-MAF
IM-32-MC
IM-32-MC
IM-32-MPW
IM-32-MPW
IM-32-PRM
IM-32-PRM
IM-32-QMB
IM-32-QMB
Acknowledgment of Receipt of Hysterectomy Information
Acknowledgment of Receipt of Hysterectomy Information
Certificate of Medical Necessity (only for the Durable Medical Equipment Program)
Certificate of Medical Necessity (only for the Durable Medical Equipment Program)
Medical Referral Form of Restricted Recipient (PI-118)
Medical Referral Form of Restricted Recipient (PI-118)
Oxygen and Respiratory Equipment Medical Justification Form
Oxygen and Respiratory Equipment Medical Justification Form
Second Surgical Opinion Form
Second Surgical Opinion Form
(Sterilization) Consent Form
(Sterilization) Consent Form
Newborn(2-3 Days)-1 Month
Newborn(2-3 Days)-1 Month
2-3 Months
2-3 Months
4-5 Months
4-5 Months
6-8 Months
6-8 Months
9-11 Months
9-11 Months
12-14 Months
12-14 Months
15-17 Months
15-17 Months
18-23 Months
18-23 Months
24-35 Months
24-35 Months
3 Years
3 Years
4 Years
4 Years
5 Years
5 Years
6-7 Years
6-7 Years
8-9 Years
8-9 Years
10-11 Years
10-11 Years
12-13 Years
12-13 Years
14-15 Years
14-15 Years
16-17 Years
16-17 Years
18-19 Years
18-19 Years
20 Years
20 Years
Healthy Children and Youth Screening [HCY Screening] Instructions
Healthy Children and Youth Screening [HCY Screening] Instructions
Adult Day Health Care
Adult Day Health Care
Aged and Disabled Waiver
Aged and Disabled Waiver
AIDS Waiver
AIDS Waiver
Ambulance
Ambulance
Ambulatory Surgical Center
Ambulatory Surgical Center
Community Psychiatric Rehabilitation
Community Psychiatric Rehabilitation
Comprehensive Day Rehabilitation
Comprehensive Day Rehabilitation
Durable Medical Equipment
Durable Medical Equipment
Environmental Lead Assessment
Environmental Lead Assessment
Hearing Aid
Hearing Aid
Nurse Midwife
Nurse Midwife
Optical
Optical
Personal Care
Personal Care
Physician
Physician
Private Duty Nursing
Private Duty Nursing
Behavioral Health Services
Behavioral Health Services
Rehabilitation Center
Rehabilitation Center
Therapy
Therapy
Transplant
Transplant
MO HealthNet ID Card
MO HealthNet ID Card
MO HealthNet Managed Care ID Card
MO HealthNet Managed Care ID Card
Ancillary Services Form
Ancillary Services Form
Mileage Reimbursement Trip Log & Invoice Form
Mileage Reimbursement Trip Log & Invoice Form
Missouri Contact Information for Logisticare
Missouri Contact Information for Logisticare
MO Healthnet Division Standing Order Form for Regularly Scheduled Appointments
MO Healthnet Division Standing Order Form for Regularly Scheduled Appointments
IM-29
IM-29
IM-29QMB
IM-29QMB
Nurse Midwife
Nurse Midwife
Pharmacy
Pharmacy
Physician
Physician
Prior Authorization Supporting Documents Cover Sheet
Prior Authorization Supporting Documents Cover Sheet
Prior Authorization Request (PA Request) Fillable/Savable
Prior Authorization Request (PA Request) Fillable/Savable
Prior Authorization Request [PA Request]
Prior Authorization Request [PA Request]
AIDS Waiver
AIDS Waiver
Dental
Dental
Hearing Aid - System Priced
Hearing Aid - System Priced
Hearing Aid - Manually Priced
Hearing Aid - Manually Priced
SDAC Attachment A
SDAC Attachment A
SDAC Attachment B
SDAC Attachment B
SDAC Attachment C
SDAC Attachment C
SDAC Attachment D
SDAC Attachment D
SDAC Attachment E
SDAC Attachment E
SDAC Attachment F
SDAC Attachment F
SDAC Attachment G
SDAC Attachment G
UB-04
UB-04
Hospital-Inpatient
Hospital-Inpatient
Hospital-Outpatient
Hospital-Outpatient
Rural Health Clinic Independent
Rural Health Clinic Independent
Rural Health Clinic Provider-Based
Rural Health Clinic Provider-Based
Accident Report [TPL-2P]
Accident Report [TPL-2P]
Acknowledgment of Receipt of Hysterectomy Information
Acknowledgment of Receipt of Hysterectomy Information
Addendum to the Plan of Treatment/Medical Update
Addendum to the Plan of Treatment/Medical Update
AIDS/HIV Waiver Program Addendum to the MO HealthNet Provider Agreement for Home Health or Private Duty Nursing Services
AIDS/HIV Waiver Program Addendum to the MO HealthNet Provider Agreement for Home Health or Private Duty Nursing Services
Air Fluidized/Low Air Loss Therapy
Air Fluidized/Low Air Loss Therapy
Application for Provider Direct Deposit
Application for Provider Direct Deposit
Approval Notice [IM-32]
Approval Notice [IM-32]
Authorization by Clinic Members
Authorization by Clinic Members
Authorization Determination
Authorization Determination
BCCT Temporary Medicaid Authorization
BCCT Temporary Medicaid Authorization
BSHCN Area Office County Listing
BSHCN Area Office County Listing
Bureau of Special Health Care Needs Area Offices
Bureau of Special Health Care Needs Area Offices
Certificate of Medical Necessity
Certificate of Medical Necessity
Certification of Medical Necessity for Abortion
Certification of Medical Necessity for Abortion
Certification of Need for Psychiatric Services [IM-71]
Certification of Need for Psychiatric Services [IM-71]
Certification of Need for Psychiatric Services [IM-71] form with Field Guides
Certification of Need for Psychiatric Services [IM-71] form with Field Guides
Change of Hospice Computer-Generated Letter
Change of Hospice Computer-Generated Letter
Claim Attachment Remittance Advice
Claim Attachment Remittance Advice
Clinical Edit/Step Therapy Authorization
Clinical Edit/Step Therapy Authorization
CMS-1500
CMS-1500
Dental Claim Form
Dental Claim Form
Diabetic Supplies Prior Authorization
Diabetic Supplies Prior Authorization
Dialysis Facility Manual
Dialysis Facility Manual
Division of Mental Retardation and Developmental Disabilities Regional Centers
Division of Mental Retardation and Developmental Disabilities Regional Centers
Drug Prior Authorization
Drug Prior Authorization
Edit Override Authorization
Edit Override Authorization
Eligibility Authorization [M-29]
Eligibility Authorization [M-29]
Exception Request
Exception Request
Forms Request
Forms Request
Handicapping Labio-Lingual Deviation (HLD) Device
Handicapping Labio-Lingual Deviation (HLD) Device
HCY Lead Risk Assessment Guide
HCY Lead Risk Assessment Guide
HCY Private Duty Nursing Acceptance Form
HCY Private Duty Nursing Acceptance Form
HCY Provider Monitoring Log
HCY Provider Monitoring Log
Healthy Children and Youth Screening [HCY Screening]
Healthy Children and Youth Screening [HCY Screening]
Healthy Children & Youth Pamphlet [HCY Pamphlet]
Healthy Children & Youth Pamphlet [HCY Pamphlet]
Home and Community Services Intake/Screening [DA-1]
Home and Community Services Intake/Screening [DA-1]
Home Health Certification and Plan of Treatment [HCFA-485]
Home Health Certification and Plan of Treatment [HCFA-485]
Hospice Disenrollment Computer-Generated Letter
Hospice Disenrollment Computer-Generated Letter
Hospice Drug Prior Authorization
Hospice Drug Prior Authorization
Hospice Enrollment Computer-Generated Letter
Hospice Enrollment Computer-Generated Letter
Hospice Election Statement
Hospice Election Statement
Hospice-Nursing Facility Contracts
Hospice-Nursing Facility Contracts
ID card
ID card
IM Authorized Representative [IM-6]
IM Authorized Representative [IM-6]
Individual Adjustment Request
Individual Adjustment Request
Initial Assessment-Social and Medical [DA-124A/B]
Initial Assessment-Social and Medical [DA-124A/B]
Insurance Resource Report [TPL-4]
Insurance Resource Report [TPL-4]
LCDE (LTACS Client Data Entry)
LCDE (LTACS Client Data Entry)
Level One Nursing Facility Pre-Admission Screening for Mental Illness/Mental Retardation or Related Condition [DA-124C]
Level One Nursing Facility Pre-Admission Screening for Mental Illness/Mental Retardation or Related Condition [DA-124C]
Long Term Care Pharmacy Dispensing Fee Provider Specialty Application
Long Term Care Pharmacy Dispensing Fee Provider Specialty Application
LTACS Client Report [DA-13]
LTACS Client Report [DA-13]
Managed Care Presumptive Eligibility Authorization (PC-2)
Managed Care Presumptive Eligibility Authorization (PC-2)
Medically Fragile Adult Waiver Private Duty Nursing Acceptance Form
Medically Fragile Adult Waiver Private Duty Nursing Acceptance Form
Medical Referral Form of Restricted Participants [PI-118]
Medical Referral Form of Restricted Participants [PI-118]
Medical Update and Patient Information (HCFA-486)
Medical Update and Patient Information (HCFA-486)
Notice of Case Action [IM-33]
Notice of Case Action [IM-33]
Notice of Eligibility for Nursing Facility and Other Vendor Services [IM-62]
Notice of Eligibility for Nursing Facility and Other Vendor Services [IM-62]
Notification of Spenddown Coverage
Notification of Spenddown Coverage
Notification of Termination of Hospice Benefits
Notification of Termination of Hospice Benefits
Nursing Home Claim Form
Nursing Home Claim Form
Oxygen & Respiratory Equipment and Medical Justification Form (OREMJ)
Oxygen & Respiratory Equipment and Medical Justification Form (OREMJ)
Payment for Nursing Home Care
Payment for Nursing Home Care
Personal Care Program Addendum to Title XIX Participation Agreement for Personal Care Services
Personal Care Program Addendum to Title XIX Participation Agreement for Personal Care Services
Personal Funds Account Balance Report [TPL-PF]
Personal Funds Account Balance Report [TPL-PF]
Physical Disabilities Waiver Program Addendum to MO HealthNet Provider Agreement for Home Health, Personal Care, or Private Duty Nursing
Physical Disabilities Waiver Program Addendum to MO HealthNet Provider Agreement for Home Health, Personal Care, or Private Duty Nursing
Physician Certification of Need for Personal Care Services
Physician Certification of Need for Personal Care Services
Physician Certification of Terminal Illness
Physician Certification of Terminal Illness
Prior Authorization Request Denial
Prior Authorization Request Denial
Prior Authorization Request [PA Request]
Prior Authorization Request [PA Request]
Private Duty Nursing Acceptance
Private Duty Nursing Acceptance
Psychological Services Request for Prior Authorization
Psychological Services Request for Prior Authorization
Remittance Advice
Remittance Advice
Report of Hearing Aid Evaluation [RHAE]
Report of Hearing Aid Evaluation [RHAE]
Request for Applied Behavior Analysis (ABA) PreCertification
Request for Applied Behavior Analysis (ABA) PreCertification
Request form for Consideration of Pharmacy Services
Request form for Consideration of Pharmacy Services
Risk Appraisal for Pregnant Women
Risk Appraisal for Pregnant Women
Sample Ticket Layout and Field Description
Sample Ticket Layout and Field Description
Second Surgical Opinion Form
Second Surgical Opinion Form
Section for Senior Services-Bureau of Home & Community Services
Section for Senior Services-Bureau of Home & Community Services
Service Plan [DA-3]
Service Plan [DA-3]
Service Plan Supplement [DA-3a]
Service Plan Supplement [DA-3a]
(Sterilization) Consent Form (MO-8812)
(Sterilization) Consent Form (MO-8812)
Supervisory Monitoring Log - HIV/AIDS Service Coordination
Supervisory Monitoring Log - HIV/AIDS Service Coordination
Supervisory Monitoring/Delivery Log [DA-220]
Supervisory Monitoring/Delivery Log [DA-220]
Temporary MO HealthNet During Pregnancy (QP-2)
Temporary MO HealthNet During Pregnancy (QP-2)
Temporary MO HealthNet During Pregnancy (TEMP) Authorization [IM-29 TEMP]
Temporary MO HealthNet During Pregnancy (TEMP) Authorization [IM-29 TEMP]
UB-04
UB-04
Valid Alpha and Numeric Combinations for Procedure Code Inquiry
Valid Alpha and Numeric Combinations for Procedure Code Inquiry
Weight for Height Graph, Boys from Birth to 36 Months
Weight for Height Graph, Boys from Birth to 36 Months
Weight for Height Graph, Girls from Birth to 36 Months
Weight for Height Graph, Girls from Birth to 36 Months
A
A
B-C
B-C
D-F
D-F
H
H
I-L
I-L
M
M
N-P
N-P
R-S
R-S
T-Z
T-Z
MO HealthNet Division Home Page
MO HealthNet Division Home Page
Email Support Center
Email Support Center
Fee Schedules
Fee Schedules
Provider Bulletins
Provider Bulletins
Contact Us
Contact Us
Provider Manuals
Provider Manuals
EMomed Portal
EMomed Portal
Approved MO HealthNet Transplant Facilities
Approved MO HealthNet Transplant Facilities
Chemotherapy Injection Codes
Chemotherapy Injection Codes
Dental Procedure Codes
Dental Procedure Codes
MO HealthNet Division
MO HealthNet Division
Department of Social Services
Department of Social Services
State of Missouri
State of Missouri
Centers for Medicare and Medicaid Services
Centers for Medicare and Medicaid Services
Missouri State Medical Association
Missouri State Medical Association
Wipro Infocrossing
Wipro Infocrossing
Job Postings
Job Postings
Overview
Overview
Submit Resume
Submit Resume
Locations
Locations
Request Information
Request Information
HOME
RESOURCE CENTER
FORMS
QUICK LINKS
ABOUT WIPRO INFOCROSSING
State of Missouri
MO HealthNet Manuals
Manual Archives
Your complete source for all MO HealthNet
related services and support for the State of MO
Search:
Manual:
All Archive
AIDS Waiver
Adult Day Care Waiver
Aged and Disabled Waiver
Ambulance
Ambulatory Surgical Center
Behavioral Health Adult Targeted Case Management
Behavioral Health Services
CSTAR
Community Psych Rehab Program
Comprehensive Day Rehab
DD Waiver
Dental
Durable Medical Equipment
Environmental Lead Assessment
Hearing Aid
Home Health
Hospice
Hospital
Medically Fragile Adult Waiver
Nurse Midwife
Nursing Home
Optical
Personal Care
Pharmacy
Physician
Private Duty Nursing
Rehabilitation Centers
Rural Health Clinic
School District Administrative Claiming Manual Effective July 1, 2019
School-Based IEP Direct Services Cost Settlement Manual
School-Based Individualized Education Plan Specialized Transportation Services
Targeted Case Management for Individuals with Developmental Disabilities
Therapy
Transplant
Youth Targeted Case Management
Month:
-Select One-
Year:
-Select One-
Search Tips
Please enter the Archive Search criteria at the top of the page.
Please Note: The month and year are optional.
VIEW BY DATE
|
ARCHIVE FILES SEARCH
©2008 IHS