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Verifying Eligibility for MO HealthNet Participants and Managed Care Members
Act
immediately
Effective date
Jul 16, 2026
Identified
Jul 17, 2026
Summary
MO HealthNet has issued mandatory eligibility verification requirements effective immediately. Providers must verify participant eligibility before every visit using real-time verification methods (eMOMED system, phone, or batch submission) and confirm active eligibility on the exact date of service. This applies to both Fee-For-Service participants and Managed Care members, with an additional requirement to verify with the specific Managed Care health plan for MC members.
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What to do
immediately · 6 steps
01Billing team must implement pre-visit eligibility verification workflow for all MO HealthNet participants before claim submission.
02Front desk staff must verify eligibility in eMOMED system or via phone to Provider Communications at (833) 222-7916 or (573) 751-2896 before every appointment.
03For Managed Care members, staff must also contact the specific health plan to verify current eligibility before each visit.
04Update encounter forms and check-in procedures to document date of eligibility verification.
05Implement system rule to flag claims if eligibility was not verified on date of service—claims will be denied without proof of active eligibility on the service date.
06Train all front desk and billing staff on the three verification options (MO HealthNet ID, Social Security Number, or Case Head ID + DOB) and batch submission process for high-volume verification.
If missed: Failure to verify eligibility will result in claim denials and non-reimbursement.
Original notice
Verifying Eligibility for MO HealthNet Participants and Managed Care Members
mydss.mo.gov · Always check the source before changing claims.
Related changes
See all Missouri Medicaid (MO HealthNet) changes →Participant Eligibility Training ToolMediumEffective Dec 22, 2014 · Provider NoticeVerifying Participant EligibilityMediumEffective Apr 24, 2017 · Provider Notice5 Easy Tips to Keep MO HealthNet (Medicaid) Claims from DenyingMediumEffective Jan 28, 2026 · Provider NoticeBrowse every Missouri Medicaid (MO HealthNet) change in the policy list