MedicaidAdministrativeMedium impact
Proper Billing for Drugs Billed to MO HealthNet
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Jul 8, 2022
We identified it
Jun 20, 2026
Summary
Missouri Medicaid (MO HealthNet) is beginning desk audits to ensure providers use correct billing units for drug claims, with potential overpayment recovery for incorrect units. Providers must maintain adequate documentation and can attend training webinars in August 2022.
Action Required
Immediately: Review Section 15 of the Pharmacy Provider Manual to ensure correct billing units for all drug claims to MO HealthNet. Verify adequate documentation exists for all drug claims as defined in 13 CSR 70.3.030(2)(A). Consider attending MO HealthNet webinars on August 3rd (1-2pm) or August 31st (9-10am) for proper billing guidance. Maintain all records for 5 years and ensure they are available at service location for potential desk audits.