MedicaidAdministrativeMedium impact
Provider Address Changes
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
May 11, 2015
We identified it
Jun 20, 2026
Summary
Missouri Medicaid (MMAC) has implemented new provider enrollment procedures requiring all providers whose address has changed since initial enrollment to submit updated information using the Provider Update Request form. The form must be submitted via email or fax with specific requirements for different provider types.
Action Required
Immediately: Providers with address changes since initial enrollment must complete the Provider Update Request form and submit to MMAC via email (mmac.providerenrollment@dss.mo.gov) or fax (573-751-5065). Complete Sections 1 and 2, ensure form is signed, and include effective dates. Note: APRNs, Nurse Midwives, Assistant Physicians, Home & Community Based providers, and clinics cannot use EMOMed for address updates and must use this form. Failure to follow instructions may result in denial of request.