Traditional MedicareReimbursementMedium impact
Re-Pricing Medicare Inpatient Hospital Claims
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
We identified it
Jun 20, 2026
Summary
This is a reminder policy clarifying that MO HealthNet re-prices Medicare Part A and Part C/Advantage inpatient hospital crossover claims to potentially cover deductibles and coinsurance when MO HealthNet's fee schedule exceeds Medicare payments. The policy has been in effect since 1991 and applies specifically to QMB-eligible participants in Missouri.
Action Required
Immediately: Missouri hospital billing teams should verify their systems properly handle Medicare Part A and Part C crossover claims with claim adjustment reason code OA-045 and remittance advice remark code N-59. Ensure staff understand that amounts not reimbursed by MO HealthNet for allowable crossover claims cannot be billed to participants. Review patient eligibility dates to confirm MO HealthNet coverage on admission day for deductible responsibility.