MedicaidAdministrativeMedium impact
Participant Administrative Lock-In
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
May 5, 2014
We identified it
Jun 20, 2026
Summary
MO HealthNet participants may be restricted to specific providers (locked-in) for services, and payment cannot be made to other providers except for emergencies or authorized referrals. Referrals require completion of form PI-118 with matching NPIs, and the form is valid for only 30 days from the service date.
Action Required
Immediately: Billing team must verify MO HealthNet participant eligibility for lock-in status before scheduling. For locked-in participants needing referrals, ensure referring provider completes Medical Referral Form PI-118 with correct NPI and taxonomy codes. Submit referral forms via eMOMED portal or mail to Wipro Infocrossing within 30 days of service. For emergency services to locked-in participants, submit paper claims with Certificate of Medical Necessity and medical records documenting emergency circumstances.