Medicare AdvantageAdministrativeMedium impact
Non-QMB, Medicare Part C Plan
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Oct 14, 2014
We identified it
Jun 20, 2026
Summary
Missouri Medicaid (MO HealthNet) has updated its coordination of benefits policy for Non-Qualified Medicare Beneficiary participants enrolled in Medicare Advantage/Part C plans. Providers cannot bill participants for unpaid balances when Medicare Advantage represents all or part of the Medicaid allowable amount, and Medicaid will pay the difference between their allowable amount and what Medicare Advantage pays.
Action Required
Immediately: Billing team must review coordination of benefits procedures for Missouri Medicaid patients with Medicare Advantage plans. Ensure billing software is configured to not bill patients for unpaid balances when Medicare Advantage payment represents all or part of the Medicaid allowable amount. Update patient billing procedures to comply with Missouri regulation 13 CSR 70-4.030.