MedicaidAdministrativeHigh impact
Participant Liability (Balance Billing)
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Jun 10, 2020
We identified it
Jun 20, 2026
Summary
MO HealthNet providers cannot bill participants for covered services even if claims are denied for procedural reasons like missing prior authorization. Participants can only be billed for non-covered services with prior written consent documenting their financial responsibility.
Action Required
Immediately: Billing team must stop balance billing MO HealthNet participants for covered services that were denied due to prior authorization or other procedural issues. Create written consent forms for non-covered services that include service date, description, participant signature, and date signed. Train staff to obtain signed consent before providing any non-covered services. Review current billing practices to ensure compliance with balance billing restrictions.