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MedicaidAdministrativeMedium impact

Participants with Other Insurance Coverage

Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

MO HealthNet participants may have commercial insurance that must be billed first, with MO HealthNet paying only after valid denial from commercial carrier. Providers can update participant insurance information using TPL-4 form when changes are discovered.

Action Required

Action needed
Immediately: Billing team must verify all MO HealthNet participants for commercial insurance coverage before billing. Always bill commercial insurance first and obtain valid denial before submitting to MO HealthNet. Complete and submit TPL-4 form to MO HealthNet Division when discovering unreported commercial insurance coverage. Update billing workflows to prevent duplicate payments.

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