MedicaidAdministrativeMedium impact
Handling Suspended Personal Care Claims
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Apr 30, 2026
We identified it
Jun 20, 2026
Summary
New guidance for handling suspended personal care claims requires waiting 1-3 business days for automatic processing before taking action. When claims are denied, billing teams must verify units don't exceed authorized amounts in Fusion system and ensure exact data matching between EVV and eMOMED systems.
Action Required
Immediately: Update suspended claim workflow - wait 1-3 business days before resubmitting suspended personal care claims. Train billing team to check Fusion system for authorized units before resubmission and verify exact data matching between EVV and eMOMED systems including NPI, taxonomy codes, participant ID, procedure codes, modifiers, and total units. Use 'Copy Claim Original' feature in eMOMED to adjust units when denied for exceeding authorized amounts.