Medicaid Credentialing – How to Submit Your Applications

Jun 30, 2023

Once you’ve decided to accept Medicaid patients, it’s time to get credentialed with MO HealthNet (Missouri’s Medicaid provider) and any Managed Care Plans you choose to accept in your practice.

MO HealthNet Dental Application

This application will allow you to bill for Fee-For-Service or Traditional Medicaid patients with your issued MO HealthNet provider number.

If your practice is new to Medicaid as a whole, an application will need to be submitted for each location you plan to treat Medicaid patients using the corresponding group NPI.

Credentialing with Managed Care Plans will be covered later in this post.

1. Go to MMAC.MO.GOV Provider Enrollment and select 'Apply to be a Missouri Medicaid Provider' (First blue bullet point near the middle of the page)

Take care to read through the red text on this page before continuing. It contains important instructions for completing your application that will help you avoid delays.

You will also find the Provider Enrollment email address and Help Desk phone number (573) 635-3559 should you have questions about your application.

Once you have read through all the information, click the 'Continue' button at the bottom of the page.

2. Choose 'NEW Provider Enrollment Applications'

If you started an application in the past and did not submit it, you can also retrieve the draft using the second option.

3. Select '40 Dentist' from the drop-down menu and click 'Next.'

4. From here, you can fill in the necessary information and submit your application.

The information you need to include can vary from provider to provider. Use the MO HealthNet Enrollment Presentation for tutorials based on your situation. Your enrollment options include

· Dentists working with an enrolled group (your place of practice is already credentialed)

· Individual billing providers enrolling under their Social Security Number

· Individual billing providers enrolling under a NON-enrolled group (place of practice is not credentialed and you do not own it)

· Enrolling an entity (your place of practice is not credentialed, and you own it)

o This will be a separate application from your individual application.

For questions regarding which guidelines to follow based on your situation, don’t hesitate to reach out to Jessica Emmerich, your Medicaid Mentor.

5. Once you submit your online application, print and sign the confirmation page (last page).

6. Fax the confirmation page and the following documents to (573) 634-3105 in one transmission.

· Copy of Provider License or Social Security Card

· Title XIX Participation Agreement

· Business Organizational Structure Form

· EFT Document

· Voided Check or Bank Letter

It is essential to include the signed last page of the application as it contains your confirmation number, without which your application cannot be processed.

You can also mail your documents, but this will result in slower application processing.

Once you have completed the online application and faxed the required documents, your application should process in two to three weeks.

Tip: Wait two days after submitting, then email MMAC to make sure they have received everything. It is unlikely you will be notified if you missed something.

You can email MMAC at any time to check the status of your application. Always include your NPI. They cannot use your tax ID or your name to check your status. They usually respond within 48 hours.

Credentialing with Managed Care Plans

You can enroll with Managed Care Plans immediately after submitting your MO HealthNet application. You do not have to be approved by MO HealthNet first.

Each Managed Care Plan is its own insurance company. You can choose to enroll with all of them, or a select number. The process is different for each plan as they are separate entities.

Use the links below to access the Managed Care Plan applications. To learn more about Fee-for-Service and Managed Care Plans (and why you might choose one over the other) check out our Medicaid Mini – Meet Your Payors.

Currently, application processing for Managed Care Plans takes 45 – 60 days.

When Can I Start Seeing Medicaid Patients?

You have a few choices when it comes to timing.

You can wait until you are credentialed to start providing Medicaid services and you will see reimbursement about two weeks after claims are submitted.

You can also start seeing Medicaid patients (Fee-for-Service and Managed Care Plans) while your application is in process. You will not be able to submit claims for reimbursement until you are credentialed, but you do have the option to offer treatment before your application is approved.

Of course, this practice comes with a certain amount of risk and does not guarantee reimbursement.

Managed Care Plans can backdate your credentialing enrollment to the date your application was completed and will cover services rendered during your application processing. MMAC can backdate your enrollment up to a year.

So, if you have already seen Fee-for-Service Medicaid patients and decide you would like to collect reimbursement, you can apply for credentialing and ask MMAC to back-date your application to the earliest date of service (given it falls within a year of your actual application submission date).

Again, you may not submit these claims until you are credentialed and are not guaranteed reimbursement.

How Will I Know to Revalidate?

About eight months ahead of your revalidation date, MMAC will send an email reminding you to revalidate soon. Six months before your revalidation date, you will receive a letter in the mail.

Once credentialed, you can also check EMOMED, the MO HealthNet portal, at any time for your revalidation date and everything needed to complete the process.

Get Started, Today

To start the credentialing process, open MMAC.MO.GOV Provider Enrollment and follow the steps outlined above!

Need Some Guidance?

For questions and additional support, email Jessica Emmerich, your Medicaid Mentor. You can also reach her by phone or text at (573) 536-2474.