MedicaidAdministrativeMedium impact
Participant Lock-In
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Oct 16, 2014
We identified it
Jun 20, 2026
Summary
MO HealthNet (Missouri Medicaid) participants may be locked-in to specific providers, and claims for services from other providers require a completed Medical Referral Form (PI-118) signed by the authorized lock-in provider. The referral form is valid for only 30 days from the date of service and must be submitted via eMOMED or mail, not fax.
Action Required
Immediately: Billing team must verify MO HealthNet participant eligibility using eMOMED or IVR system (573-751-2896) to identify lock-in restrictions. For locked-in participants receiving services from non-authorized providers, ensure Medical Referral Form PI-118 is completed by the authorized lock-in provider before service delivery. Submit PI-118 forms via eMOMED or mail to Wipro Infocrossing within 30 days of service date. Claims for restricted participants without proper referral forms will not be paid.