Provider Resources
Get the tools you need to easily manage your administrative needs, and your keep your focus on the health of your patients. Use the tools and resources below to find the information you need, check member eligibility, submit claims through our secure provider portal, check if pre-authorization is necessary, see the status of a claim and more
- Medicaid Out of Network and Exceptions Form (PDF)
- PCP Change Form - English (PDF)
- PCP Change Form - Spanish (PDF)
- Interpreter Services Request (PDF)
- Provider Refund Form (PDF)
- Outpatient Prior Authorization Form (PDF)
- Inpatient Prior Authorization Form (PDF)
- Outpatient Treatment Request Tip Sheet (PDF)
- Ownership and Controls Disclosure Form (PDF)
- Acknowledgement of Receipt of Hysterectomy Information (PDF)
- Certification of Medical Necessity for Abortion Consent Form (PDF)
- Provider Reconsideration and Appeal Form (PDF)
- Sterilization Consent Form (PDF)
- Notification of Pregnancy (NOP) Submission Requirement (Effective September 2) (PDF)
- Missouri Tobacco Quitline for Patients with a Behavioral Health Condition or Substance Use Disorder who also use tobacco
- Show-Me ECHO: Extending Specialty Care into Primary Care - (Extension for Community Healthcare Outcomes) uses videoconferencing technology to connect a team of interdisciplinary experts with primary care providers. The discussions with, and mentoring from, specialists help equip primary care providers to give their patients the right care, in the right place, at the right time.
- Joint Surgery - Evolent Utilization (PDF)
- Spine Surgery - Evolent Utilization (PDF)
- Important Billing & Payment Tips (PDF)
- Musculoskeletal Management Program Educational Webinars FAQs (PDF)
- Musculoskeletal Management Program Educational Webinars Quick Reference Guide (PDF)
- HEDIS Quick Reference Guide 2024 (PDF)
- HEDIS Provider Pocket Guide 2024 (PDF)
- NIA Utilization Review Matrix Medicaid - 2024 (PDF)
- Medicaid Hospital Inpatient and Outpatient Billing Notification (PDF)
- Turning Point Cardiac Surgical Program FAQs (PDF)
- Pre Auth Training Resource (PDF)
- Ears, Nose & Throat Surgery & Sleep Study Program FAQs (PDF)
- Ophthalmology Notice Quick Reference Guide (PDF)
- Transportation Services (PDF)
- Care Management Programs 2024 (PDF)
- Provider Quick Reference Guide (PDF)
- CAHPS Tip Sheet for Providers (PDF)
- EPSDT At A Glance (PDF)
- RHC Billing Guideline (PDF)
- HCY/EPSDT Preventive Visit Examples (PDF)
- PaySpan Information Sheet (PDF)
Home State providers must keep accurate and complete medical records. Such records will enable providers to render the highest quality healthcare service to members. They will also enable Home State to review the quality and appropriateness of the services rendered. Home State will conduct random medical record audits as part of its QI program to monitor compliance with the medical record documentation standards linked below.
The coordination of care and services provided to members, including over/under utilization of specialists, as well as the outcome of such services also may be assessed during a medical record audit. Home State will provide written notice prior to conducting a medical record review.