Provider Toolkit
Getting Started
Credentialing with Dental Medicaid Payors
Learn how to enroll with MO HealthNet, credential with Managed Care Plans, and prepare your practice for successful Medicaid participation.
Medicaid Mini-Series: Credentialing 101
Medicaid Mini-Series: Meet Your Payors
MCOH Credentialing Checklist
Enrolling with MO HealthNet
Enrolling with Managed Care Plans
When Can I Start Seeing Medicaid Patients?
Providers have flexibility in when they begin treating Medicaid patients.
Option 1: Wait Until Enrollment Is Approved
This option allows claims to be submitted immediately after credentialing is complete.
Option 2: Begin Seeing Patients During Enrollment Processing
Providers may choose to begin treating Medicaid patients while enrollment applications are still pending.
However, reimbursement is not guaranteed until enrollment is approved and claims are successfully submitted.
Managed Care Plans may backdate enrollment to the application submission date. MO HealthNet may also backdate enrollment for eligible claims up to one year.
How Will I Know to Revalidate?
About eight months ahead of your revalidation date, MMAC will send an email reminding you to revalidate soon. Six months before your revalidation date, you will receive a letter in the mail.
Once enrolled, you can also check EMOMED, the MO HealthNet portal, at any time for your revalidation date and everything needed to complete the process.
Set Up for Success
Incorporating Medicaid into Your Practice
Explore strategies and operational guidance to help your practice successfully integrate Medicaid patients while maintaining workflow efficiency and financial sustainability.
Medicaid Mini-Series: Your Practice, Your Way
Review the most successful ways to incorporate Dental Medicaid into your practice.
ADA’s Medicaid Financial Sustainability Toolkit
Guidance and strategies to help practices deliver quality care while maintaining profitability.
Preventing No-Shows
Building trust and creating a welcoming patient experience can significantly improve appointment attendance and long-term patient retention.
Common Strategies
- Reminder calls or texts
- Clear appointment expectations
- Flexible scheduling policies
- Transportation support information
- Consistent patient communication
See how this practice addressed patient attendance to improve their bottom line.
Transportation Support
MO HealthNet offers non-emergency medical transportation that may help patients attend dental appointments.
Make sure eligible patients are aware of this benefit before their visit.
Helpful Contacts/Resources/Troubleshooting
Checking-In Medicaid Patients
Patient eligibility should be verified before every appointment to help prevent denied claims and unexpected coverage issues.
To verify patient eligibility, visit MO HealthNet Portal and click “Participant Eligibility”, or call Provider Communications at (573) 751-2896.
You will need one of the following:
- Patient DCN, found on their MO HealthNet or Managed Care card
- Patient last name, first name, and date of birth
- Patient Social Security Number and date of birth
Before Treatment, Confirm:
- Active eligibility
- Coverage limitations
- ME code restrictions
- Prior authorization requirements
Some eligibility groups or categories of assistance have benefit restrictions, and claims made on non-covered services will end in rejection.
Before proceeding with service, check your patient’s coverage by following the same steps you would take to verify their eligibility, and then reviewing their coverage details.
Checking coverage ahead of time not only prevents rejection but also helps you navigate patient needs and make treatment recommendations with confidence during the appointment.
If the services needed are not covered, they are the patient’s responsibility. Learn more about ME Codes and group limitations here.
Check that scheduled services do not require prior authorization, and that authorization has been received before proceeding. Review the current Dental Provider Manual regularly for updates to services needing prior authorization.
Adding Medicaid to Your Patient Roster
For providers who already have a decent patient load, adding Medicaid services can feel like an overwhelming venture.
The good news is you don’t have to see every Medicaid patient. You have control over the kind and number of patients you see.
Providers can establish participation guidelines that support both patient access and practice sustainability.
Common Approaches
- Percentage-Based Scheduling: Reserve a set percentage of appointments for Medicaid patients.
- Age-Based Focus: Limit participation to specific patient populations, such as pediatric or senior patients.
- Referral-Based Scheduling: Accept Medicaid patients referred through physician or specialist networks.
- Dedicated Appointment Days: Designate specific days for Medicaid appointments to help balance scheduling demands.
- Important: Avoid limiting Medicaid appointments to restricted appointment times, as this may be considered discrimination.
Tip: Clearly outline your Medicaid participation guidelines within your office policies and communicate accepted care plans to patients.
Medicaid Mini-Series: Decoding the Codes
Get a better understanding of which ME codes your patients are qualified to use based on their demographics. >
Filing Like a Pro
Pre-Authorizations and Claims
Understand how to navigate pre-authorizations, submit accurate claims, and troubleshoot reimbursement issues across MO HealthNet and Managed Care Plans.
Medicaid Mini-Series: Coding Claims with Confidence
This session walks you through the ME codes needed for qualifying patients, and the proper way to submit their claims.
When and How to Submit Pre-Auth Requests
Section 5 of the Dental Provider Manual provides a comprehensive list of covered procedure codes. Use the "PA" column to determine which procedures require a pre-authorization. This chart can be used to determine required pre-auths for patients covered by MO HealthNet.
For patients covered by a Managed Care Plan, please refer to that plan's resource.
Tip: Request a provider manual, fee schedule, and pre-auth list to cover your bases.
For patients covered by MO HealthNet, pre-auth requests should be sent to Wipro Infocrossing along with other required documentation. These will appear in eMOMED once processed.
Wipro Infocrossing
P.O. Box 5700
Jefferson City, MO 65102
If the patient is covered by a Managed Care Plan, pre-auth requests can be made and managed through that plan's online portal.
Submitting Claims
Fee-for-Service (MO HealthNet) care is billed through the eMOMed portal.
- Once logged in, choose ‘Claim Management’ to begin your claim submission.
- Next select ‘New Claim’ and then ‘Dental’.
- Start by populating the Participant Information fields. These fields must match the patient’s MO HealthNet ID Card exactly for their claim to be accepted and processed.
- The Patient Account Number is based on your practice’s records management system. It is an optional field.
- Next enter the NPI of the performing provider and the place of service. The field for ICD10 code is optional.
- Once complete, you can save your Claim Header. Now you’re ready to add procedure details.
- Under the Dental Details section, enter the Date of Service, the performing provider’s NPI, and the procedure code.
- Now under ‘billing charges’ you should enter what your practice charges for this procedure, not what you know to be the current reimbursement.
- If MO HealthNet later increases their reimbursement for this procedure, your practice can be retroactively paid for the difference.
- Then enter the Units, Diagnostics Code and Place of Service. Select Save.
- Continue adding Procedure Details line by line for this Claim until complete.
- Once complete, you can submit your claim.
Providers are encouraged to attend one of the dental provider billing webinars found on the Provider Training Calendar. These 2-hour interactive webinars will walk you through the entire eMOMED claims process.
Managed Care Plans use their unique portal for submitting claims.
Select one of the Managed Care Plans below for details on how to submit claims in their portals:
- HealthyBlue – DentaQuest
- Home State Health – Envolve
- United Healthcare
Once you’ve submitted your claims, you can check status within each plan’s portal.
If you have questions about any of your submitted claims, you can follow up by email or through the chat or email features within the respective plan’s portal:
- MO HealthNet – email through eMOMed or call (573) 751-2896
- HealthyBlue – call 800-233-1468
- Home State Health – email ProviderRelations@envolvehealth.com or call 855-434-9240
- United Healthcare – email Missouri_PR_Team@uhc.com or call 800-822-5353
Tip: Some patients are covered by primary insurance as well as Medicaid. These insurers must be filed with before Medicaid, otherwise claims will be rejected. When filing claims, verify patient insurance information and submit primary insurance claims before moving on to Medicaid.
Retroactive Reimbursements
Providers can submit claims for reimbursement up to 12 months beyond the date of service for MO HealthNet patients. And if past claims get denied for error, providers have up to 24 months from the date of service to correct and re-file with MO HealthNet.
Wondering About Your Reimbursements?
Log in to eMOMed to research or submit past claims, check on patient eligibility, or send related questions. You can also check out related blog resources for additional support.
From the Payors
Trusted Resources
Access provider manuals, billing guidance, training opportunities, policy updates, and support tools from Missouri Medicaid payors and dental organizations.
MO HealthNet
As the home of Missouri Medicaid, MO HealthNet has a plethora of resources for providers regarding claims, plan coverages, updates to Medicaid, and expert support.
If you’re seeking information regarding changes to Medicaid, be sure to check into your eMoMed portal or visit MO HealthNet News.
Claims and Billing Resources: Access your provider portal, find claim filing tools, and the latest payment schedule.
MO HealthNet Billing and Policy Training
Provider Manuals: Manuals for both FFS and Managed Care providers.
Healthy Blue (DentaQuest) Provider Training: Step-by-step training resources.
Home State Health (Envolve) Provider Resources: Guidelines on each step of working with Envolve.
United Healthcare Provider Resources: An overview to working with UnitedHealthcare and links to more resources.
Get in Touch:
Contact MO HealthNet’s eMOMED support team at 833-222-7916, or visit eMOMED to access support with eligibility, claim filing, resolution and disposition, and participant verification.
Providers can contact MO HealthNet Education at MHD.Education@dss.mo.gov or (573) 751-6683 for other claim and policy information.
MDA and ADA Resources
The go-to source for any dentistry question. The MDA and ADA have a wide range of resources on Medicaid and everyday hiccups to help keep your practice running smoothly.
Practice Topics & FAQ: Find answers to frequently asked questions on a myriad of topics.
Medicaid Resources: Access provider toolkits, webinars, as well as Medicaid advocacy information.
Medicaid Legal News & Updates: Resources for new providers, Medicaid FAQs, and toolkits for integral care and hospitals.
Member Portal: The hub for all MDA and ADA resources. This link will take you straight to information on Medicaid.
Get in Touch:
The MDA has a dedicated support staff that can point you in the right direction to get the answers you need. Contact the MDA directly or request support through the member portal.
Home State Health
Coding Resources: Billing and coding tips for special cases. You can find general billing and claims tips here.
Provider Tools: Forms, manuals, and provider resources. Don’t forget to look at the additional resources at the bottom!
Provider Quick Links: All the resources you need to get set-up with HSH, including provider trainings and manuals you can always reference.
Provider News: Updates on claims, billing, and policy news.
Get in Touch:
- 877-236-1020 (Home State Health)
- 855–694-4663 (SMHK)
- Contact a representative.
- HomeStateProvider@centene.com
- Request support through the provider portal.
Show Me Healthy Kids (Managed by Home State Health)
Provider Resources: Manuals and billing support for SMHK.
Provider Quick Reference Guide: Get FAQs on claims, coding, and Envolve Dental.
Provider Training Resources: Sign up for live or access on-demand training.
Get in Touch:
- 877-236-1020 (Home State Health) or 855–694-4663 (SMHK)
- Contact a representative.
- HomeStateProvider@centene.com
- Request support through the provider portal.
Healthy Blue Resources
While on Healthy Blue’s website, be sure you remain on the correct provider pages. You can check this by looking at the top left-hand side of the menu, to the right of their logo. It should read ‘Missouri Providers’ or ‘Medicare Providers’.
Provider Manuals & Guides: Guidelines and a useful Quick Reference Card.
Reimbursement Policies: Current rates and info on coding and submitting claims.
Provider News: Policy updates and upcoming education events.
Provider Training: Register for live webinars or events.
Get in Touch:
- 833-388-1407
- Message Healthy Blue
- Request support through the provider portal.
United Healthcare Resources
Claim Information: Clinical guidelines and how to code and submit claims.
Provider Resources and Support: The ultimate list of UHC resources plus tools for providers.
FAQs: Common questions about plans and claims answered.
Provider News: News on education and policy updates. Sign up for the UHC newsletter to stay informed.
Medicare Advantage Overview Training: Navigating the UHC system and the QRG Book. Get credit for completing this quick course!
Get in Touch:
- 800-822-5353
- Request support through the provider portal.
Here for You at Every Step
Schedule A Session
Medicaid can seem overwhelming, but we're here to help. Your Dental Medicaid Facilitator, Lori Reed, is here to talk about your challenges or questions.
Schedule a one-on-one session below or email Lori at lreed@oralhealthmissouri.org.