Missouri Provider Enrollment – Frequently Asked Questions

Note: The information provided within this FAQ page is according to the state, unless otherwise indicated (i.e., some areas indicate “According to CMS/Medicaid”).

For full information regarding Provider Medicaid Enrollment in Missouri, please visit the “Missouri Department of Social Services, Provider Enrollment” section.

For answers to general questions, please review the FAQs below.

Who is required to enroll in the state Medicaid program?

  • Performing (Rendering)
  • Billing
  • Ordering, Referring, Prescribing (ORP) (Paper application only)

I am enrolled as a participating provider in another state’s Medicaid program. Am I also required to enroll in Missouri’s Medicaid Program to provide services to Medicaid beneficiaries?

Yes, providers must be enrolled with MMAC to be reimbursed for medical services provided to MO HealthNet Participants.

How do I enroll?

Navigate to the MO HealthNet Provider Enrollment portal and complete the online application.

Providers who cannot enroll electronically can request an application package by email at MMAC.ProviderEnrollment@dss.mo.gov.

Note: ORP Providers must submit a paper application.

How does my registration relate to billing for services?

You must register with the state using the same identifiers you plan to bill with, i.e., TIN/SSN, Specialty, etc.

The following items must be in alignment:

  • Your contract with Envolve / Centene Dental and Vision
  • State Registration
  • Billing Set Up / Configuration

Are there additional requirements and screenings based on risk/risk level?

According to CMS/Medicaid:

Requirements by Risk Level:

  • All Risk Levels:
    • Verify provider meets any applicable Federal regulations or State requirements for the provider type prior to making an enrollment decision.
    • License Verifications.
    • Conduct Database checks.
  • Limited Risks:
    • Site visit.
  • High Risks:
    • Any provider that has a payment suspension based on a credible allegation of fraud within the last 10 years.
    • Any provider excluded within the past 10 years by HHS-OIG or a State Medicaid Agency (SMA).
    • Any provider that has a qualifying Medicaid overpayment.
    • The provider is enrolling within 6 months of the lifting of a temporary moratorium that at the time would have barred the provider’s enrollment.

States may impose additional screening methods “in addition to or more stringent than” those in the regulations. This could result in a change in the risk category assigned for certain types of providers. Providers should check with their SMA to determine their risk category.

Additional requirements based on Provider’s assigned risk level can be found on the “Missouri Department of Social Services” website.

What is the enrollment application processing timeframe?

The state does not provide this information; however, according to Missouri Medicaid Audit & Compliance (MMAC), they offer same-day or overnight approvals for most new provider enrollment applications for physicians, advanced practice nurses, and other licensed practitioners.

What is my Enrollment Effective Date? / How is my Enrollment Effective Date Determined?

According to the State, the enrollment effective date cannot be prior to the effective date of required program documents, such as license, certification, etc.

How do I find proof of registration?

Once enrollment is finalized, an email that includes the provider’s effective date will be sent to the provider.

I am enrolled but recently received a letter from the State saying that I need to re-enroll, re-register, or revalidate my information. What do I need to do?

According to the State:

  • Reenrollment: For providers previously active but in an inactive status at the time their application is submitted to MMAC.
  • Revalidation: For providers with no break in their active status.

All business types except Sole Proprietors without a DBA must register with the Missouri Secretary of State. Businesses based in other states must register both with their home state and as a foreign entity in Missouri.

How often do I need to re-enroll, re-register, or revalidate my information?

Providers are required to revalidate at least every five (5) years.

I received a letter from Envolve / Centene Dental and Vision Services about my registration status. What do I do?

Your state provides us with information about each provider’s registration status regularly. If we received information that your registration is not active:

  • Validate your state registration status to confirm if there are any outstanding items needed to activate your registration.
  • Remember, you’re required to revalidate your information regularly with the state.
  • If you have proof of current/valid registration, contact us.

Who do I contact if I have questions about my enrollment/registration or need more information?

If any of my information changes, what do I need to do and who do I need to notify?

Keep your information up to date!

Any time you have a change to your information, be sure to notify us and update your state portal.

Here are some examples of details you should keep updated:

  • Office Address (including suite number)
  • Office Hours
  • Mailing Address
  • Phone Number

To check the information that Envolve / Centene Dental and Vision has in our system and published for you, visit our Find A Provider tool on our website. If you find discrepancies or need updates, contact us to report and update the information.

Keeping your information current is essential for your practice, to ensure claims are processed appropriately, and for the convenience and satisfaction of our members.