MedicaidPrior AuthHigh impact
Inpatient Hospital: Validation Review
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Apr 29, 2016
We identified it
Jun 20, 2026
Summary
Missouri Medicaid requires pre-certification for all inpatient hospital admissions through Xerox Care and Quality Solutions, with quarterly validation reviews to confirm medical necessity. Providers must submit requested medical records within 30 days or face claim denials and payment recoupment.
Action Required
Immediately: Billing team must ensure all Missouri Medicaid inpatient admissions are pre-certified through Xerox Care and Quality Solutions before admission. When Xerox requests medical records for validation reviews, submit documentation within 30 calendar days to avoid claim denials and payment recoupment. Update workflows to track validation review requests and response deadlines.