Getting Started with Missouri Dental Managed Care Plans
Now that your MO HealthNet application has been approved and you have secured your Medicaid ID number, it’s time to credential with your chosen Managed Care Plans.
With each Managed Care Plan being its own insurance company, the enrollment processes can differ. Follow the steps below to start your application process with expert guidance.
1. Make a Game Plan
Before anything else, you need to determine which plans are right for your practice.
While providers are encouraged to enroll in all three Managed Care Plans, it’s not required. At minimum, providers must be enrolled with the same plan as their patient to provide eligible services. Most patients have the option to choose their Managed Care Plan.
Tip: You can see which plans your patients are enrolled with by verifying their eligibility at emomed.com. Get step-by-step guidance on verifying patient eligibility here.
Click the links below to learn more about the Managed Care Plans and who they serve.
These three plans all serve the same populations:
- Children
- Families
- Pregnant women
- Adults
Show Me Healthy Kids – Home State Health Sub-Plan
This Home State Health sub-plan serves a unique population, including:
- Children in the care and custody of the Missouri Department of Social Services
- Children or youth in alternative care
- Children receiving adoption or legal guardianship subsidy
- Former foster care youth under the age of 26, who were in foster care on their 18th birthday and covered by MO HealthNet (Missouri Medicaid), and who meet other eligibility criteria
- Former foster care youth under the age of 26, who were in foster care on their 18th birthday and covered by Medicaid from another state, and who are not currently eligible for Medicaid coverage under another program
Choosing to offer dental Medicaid through the Managed Care Plans does not mean you must also accept the plan’s PPO members. You choose who you serve.
Each Managed Care plan covers the same services as MO HealthNet and reimburses at the mandated rates. Additionally, providers have the option to negotiate their rates with the Managed Care plans through the contract process.
2. Streamline Your Process
Certain documents must be sent along with your application, and gathering these before starting your application makes for quicker submission.
When enrolling as an individual, you will be asked to provide:
- Copy of Provider License or Social Security Card
- Title XIX Participation Agreement
- Business Organizational Structure Form
- EFT Document
- Voided Check or Bank Letter
When enrolling as a group or practice, you will be asked to provide:
- Group (Type II) NPI number
- Tax ID Number or EIN
- Medicare ID number – Application fees can be waived if your practice is enrolled with Medicare
- Payee Information
- Bank Information
Tip: Depending on the plan you are enrolling with, additional documents may be required. Ensure you read through all the information at each step of your application to ensure none are missing.
3. Start Your Application
Each plan differs in its credentialing process, but all provide resources to support you along the way. Check out the links below to ensure a smooth enrollment, and when you’re ready, click “Start Your Application” to begin.
Tip: All of the Managed Care Plans require that your CAQH ProView profile is up to date before or after application submission. Ensure that your CAQH profile is accurate and that you have authorized the plans you are credentialing with are authorized to view your information and data.
UnitedHealthcare
To credential with UnitedHealthcare, you must first sign up for the UnitedHealthcare Provider Portal, then complete the Onboard Pro process.
Healthy Blue
Home State Health & Show-Me Healthy Kids
To credential with Home State Health and/or Show-Me Healthy Kids, you will first need to request a contract, then enroll with Centene.
4. Finishing Up
Once you’ve completed your submission(s), you should receive approval within 45-60 days. But before you move on, there are a few things you can do to make the most of the enrollment process.
Be sure to follow up with the plan by calling or using the links below to ensure they’ve received your application.
UnitedHealthCare – 800-822-5353
Home State Health and Show-Me Healthy Kids – 855-694-4663
Healthy Blue – 888-696-9533
What Can I Do if My Application is Rejected?
Application rejections can be discouraging, especially when the reasoning is vague. The best thing you can do is be proactive about reaching out.
To help you get clarity and avoid further delays, reach out to the plan by calling or using the links above. If you’re unable to resolve an issue with the plan directly, contact a Managed Care Liason.
Here for You at Every Step
Get personal support through your Medicaid Mentor, Lori Reed. Contact Lori through email, or schedule a one-on-one session.