MedicaidAdministrativeMedium impact
All MO HealthNet Providers Responsible for Updates
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Feb 1, 2025
We identified it
Jun 20, 2026
Summary
Beginning February 1, 2025, all Missouri Medicaid (MO HealthNet) providers must use a new Provider Update Request form to make any changes to their enrollment information. The old form will no longer be accepted, and all changes must be faxed to 573-634-3105 with proper signatures.
Action Required
Before February 1, 2025: All Missouri providers enrolled with MO HealthNet must obtain the new Provider Update Request form from MMAC for any future enrollment changes. Update office procedures to use only the new form and fax to 573-634-3105. Ensure proper signature requirements are met - individual provider signature required for main practice location updates, billing-to-performing provider changes, and Pay To information changes. For groups/clinics, only authorized personnel listed as managing employees or owners may sign.