How to Submit Medicaid Claims
Coding and billing are the final pieces of growing practice profitability with dental Medicaid.
Remember, the practice location as well as the performing provider have to be credentialed with the care plan in which the patient is enrolled. This allows you to submit the claim to the appropriate payor for reimbursement.
Fee-for-Service/Traditional Medicaid Claims
Fee-for-Service care is always billed through MO HealthNet. This care plan typically covers adults with disabilities and senior populations.
Once logged in to the eMOMed portal, Choose ‘Claim Management’ to begin your claim submission. Next select ‘New Claim’ and then ‘Dental’. See a video walkthrough here.
- 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 also 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, not the group’s, 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 its 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
When billing for Managed Care Plans, use their unique portal.
Check out our Dental Provider Credentialing, Policy & Claims post to learn more about submitting claims with each of the Managed Care Plans.
Once you’ve submitted your claims, you can check the 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 – ProviderRelations@envolvehealth.com or call 855-434-9240
- United Healthcare – Missouri_PR_Team@uhc.com or call 800-822-5353
Five Steps to Avoid Claim Rejection
1. Verify Patient Eligibility Before Service
Patient eligibility should be verified at the beginning of each appointment, ensuring claims won’t be rejected due to a lack of coverage.
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
View our post, Verifying Patient Eligibility, to learn more.
2. Check Patient Coverage
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.
3. Ensure Services Do Not Require Prior Authorization
Certain services require prior authorization before performing the service and without it your claim will be denied.
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.
For more information on submitting pre-authorization requests, check out our How to Submit Dental Medicaid Pre-Auth Requests post.
4. File With Primary Insurance First
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.
5. File Claims in a Timely Manner
For MO Healthnet, claims must be filed within 12 months of the original date of service. Managed Care plans require claims to be filed within 90 days of the original date of service. If the filing deadline is missed, the claim will be denied.
While there are ways to file past claims, it’s best practice to submit them shortly after the service date to avoid rejection and payment delay.
For more information on overdue claims, view the eMOMED General Sections Manual.
Filing and Coding Resources
Tools and guides to support accurate and efficient claim submission.
Medicaid Mini-Series: Coding Claims with Confidence
Still Unsure About Submitting Your Medicaid Claims?
Check out some additional support for Managed Care Dental Providers, as well as the education page.
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.