MedicaidAdministrativeMedium impact
Reimbursement Issues - Pricing Inquiry Process
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Feb 15, 2019
We identified it
Jun 20, 2026
Summary
Missouri Medicaid has established formal processes for providers to request review of Maximum Allowable Cost (MAC) and National Average Drug Acquisition Cost (NADAC) pricing rates for pharmaceutical reimbursement. Providers can contact specific help desks to dispute pricing and submit required documentation to potentially receive rate adjustments and resubmit claims for higher reimbursement.
Action Required
Immediately: Billing team should save contact information for MAC pricing inquiries (573) 751-6963 and NADAC Help Desk (855) 457-5264. When pharmacy reimbursement appears low, contact appropriate help desk before appealing. If requested to submit formal inquiry, complete MAC Pricing Inquiry Worksheet or NADAC Help Desk Form with invoice copy, ensuring no PHI is included. Monitor weekly NADAC rate file updates and resubmit claims if rate changes are approved.