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  • Mo Logisticare Healthnet Ancillary Services Form

Get Mo Logisticare Healthnet Ancillary Services Form

T Transportation MO HealthNet #: Phone number(s): State: Appointment Date(s) and Time(s): Facility and Clinician Name: Address: City: Phone Number: Lodging Meal Reimbursement Zip Code: State: Fax Number: Check In Date: Zip Code: Check Out Date: *Provided for participant and one parent/guardian if participant is a child. Meals Reimbursement Dates: *Maximum reimbursement of 2 meals each per day for child (outpatient) and one guardian. Facility staff or parent/guardian may fax recei.

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Missouri Medicaid (MO HealthNet) Home State Health: 855-694-4663.

In general, MO HealthNet covers low-income children; their parents, guardians, or caretakers; and aged, blind, or disabled individuals. Nevertheless, certain income and resource criteria must be met as well. Income criteria are largely based on poverty guidelines established by the federal government.

MO HealthNet's Non-Emergency Medical Transportation (NEMT) program provides free rides for eligible MO HealthNet participants.

Providers may submit claims via the Internet. The web site address is .emomed.com. Providers are required to complete the on-line Application for MO HealthNet Internet Access Account. Please reference http://dss.missouri.gov/mhd/providers and click on the Apply for Electronic/Internet System Access link.

Call the provider and ask them to bill MO HealthNet. If the provider still bills you, send the bill or a copy of the bill to the Participant Services Unit, P.O. Box 3535, Jefferson City, MO 65102. Include a note with the patient name and MO HealthNet number.

For Missouri Medicaid recipients, emergency transportation to a medical facility is always covered. However, non-emergency transportation isn't always covered by Medicaid; the non-emergency trips that are covered by Medicaid must meet a certain set of criteria and be scheduled correctly.

The claim must meet the MO HealthNet timely filing requirement by being filed by the provider and received by the state agency within twelve (12) months from the date of service.

Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided. If a claim isn't filed within this time limit, Medicare can't pay its share.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232