MedicaidAdministrativeMedium impact
HMS Hospital/Long Term Care Audits and Commercial Insurance Disallowance Audits
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Apr 27, 2021
We identified it
Jun 20, 2026
Summary
HMS will conduct post-payment audits every 90 days for Missouri Medicaid providers to identify when commercial insurance should have been billed first, requiring providers to bill commercial plans and refund Medicaid overpayments. Audit notices will be mailed to providers' addresses on file with MMAC.
Action Required
Immediately: Ensure HMS audit notices are routed to correct billing staff within organization. Verify current mailing address is on file by emailing MMAC.ProviderEnrollment@dss.mo.gov. When audit notices are received, bill identified commercial plans first and process Medicaid refunds as instructed. Contact MMAC/HMS at 573-751-3399 or MMAC.Financial@dss.mo.gov with questions.