Five Steps to Avoiding Medicaid Claim Rejections
Dec 01, 2025We’re here to make Medicaid claims easier for practices across Missouri, and that includes helping you avoid claim rejections. Review our pro tips below to avoid common claim rejection errors and keep your practice running smoothly.
1. Verify Patient Eligibility Before Service
Patient eligibility should be verified at the beginning of each appointment, ensuring claims won’t be rejected due to a lack of coverage.
To verify patient eligibility, visit MO HealthNet Portal and click “Participant Eligibility”, or call Provider Communications at (573) 751-2896. You will need one of the following:
- Patient DCN, found on their MO HealthNet or Managed Care card
- Patient last name, first name, and date of birth
- Patient Social Security Number and date of birth
2. Check Patient Coverage
Some eligibility groups or categories of assistance have benefit restrictions, and claims made on non-covered services will end in rejection.
Before proceeding with service, check your patient’s coverage by following the same steps you would take to verify their eligibility, and then reviewing their coverage details.
Checking coverage ahead of time not only prevents rejection but also helps you navigate patient needs and make treatment recommendations with confidence during the appointment.
If the services needed are not covered, they are the patient’s responsibility. Learn more about ME Codes and group limitations here.
3. Ensure Services Do Not Require Prior Authorization
Certain services require prior authorization before performing the service and without it your claim will be denied.
Check that scheduled services do not require prior authorization, and that authorization has been received before proceeding. Review the current Dental Provider Manual regularly for updates to services needing prior authorization.
For more information on submitting pre-authorization requests, check out our How to Submit Dental Medicaid Pre-Auth Requests blog.
4. File With Primary Insurance First
Some patients are covered by primary insurance as well as Medicaid. These insurers must be filed with before Medicaid, otherwise claims will be rejected. When filing claims, verify patient insurance information and submit primary insurance claims before moving on to Medicaid.
5. File Claims in a Timely Manner
For MO Healthnet, claims must be filed within 12 months of the original date of service. Managed Care plans require claims be filed within 90 days of the original date of service. If the filing deadline is missed, the claim will be denied.
While there are ways to file past claims, it's best practice to submit them shortly after the service date to avoid rejection and payment delay.
For more information on overdue claims, view the eMOMED General Sections Manual.
Filing and Coding Resources
Tools and guides to support accurate and efficient claim submission.
Coding Claims with Confidence: 2024 Session Recap
How Do I Submit My Dental Medicaid Claims for Payment?
Claims & Coding Resources: Traditional/Fee for Service Plans
Claims & Coding Resources: Managed Care Plans
Need More? You Can Rely on Us.
Get personal support through your Medicaid Mentor, Jessica Emmerich. Contact Jessica through email, or give her a call or text at 573-536-2474.