MedicaidPrior AuthLow impact
PDN Prior Authorization Adjustment Including Urgent or Emergency Situations
Missouri Medicaid (MO HealthNet)·MO·Prior Authorization
Effective date
Jul 30, 2024
We identified it
Jun 20, 2026
Summary
Private Duty Nursing (PDN) services can now be authorized across multiple provider agencies when one agency cannot staff all authorized units. Authorization adjustments between agencies are allowed, and urgent/emergency situations require notification to BSHCN within 72 hours after the event.
Action Required
Immediately: Billing team should note that PDN services may now be split between multiple agencies with separate authorizations. When billing PDN services, verify which specific agency has authorization for the units being billed. For urgent/emergency authorization adjustments, ensure BSHCN is contacted within 72 hours and document the communication for billing records.