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Home > Provider Home Page > Frequently Asked Questions (Missouri)



Provider Frequently Asked Questions (Missouri)



What is Children's Mercy Family Health Partners timely filing requirement?

By contract, participating providers with CMFHP must file a claim within 90 days from the initial date of service. CMFHP has currently extended this time frame to 180 days. If the claim is received after 180 days, the claim will be denied and the provider must write off any applicable charges. The member cannot be billed.
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How may timely filing denials be appealed?

In order for timely filing denials to be reconsidered for payment, the provider must have proof that this claim was originally filed within the 180 days and have been followed-up on within the same 180-day time period.

If it is a coordination of benefit claim, the 180 days starts from the date of the primary explanation of benefits. However, the provider must have filed in a timely manner with the primary carrier.
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Is a written referral required for a member to see a specialist(s)?

CMFHP does not require written referrals. PCPs may verbally refer a member to a specialist and document in the member's chart that this has been done.
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How long does it take CMFHP to process a "clean-claim"?

If the claim is submitted to CMFHP electronically and we require no additional information, a claim will be paid within the State-defined statutory requirement for payment of a clean-claim. Paper claims that require no additional information are paid within 30 days.
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How does CMFHP determine if the member has other insurance information?

Since CMFHP is the payer of last resort (except for EPSDTs and OB services), we first look for other payment resources. We are provided information from the state concerning COB information (verified every six months for accuracy by CMFHP). We also get information from providers when an EOB is submitted with their claim. If you have other insurance information without an EOB, include the information on the HCFA. COB information should be available on the website within the next few months.
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How do I use the website to look up claims for my practice?

Once you are set up as an authorized user, you will follow the easy steps below to check your claims status:
Login using your assigned user id and password. Go to the Office Manager menu item and then:
  • Claims
  • Inquiry
  • Member Information
    • - Fill in the fields with the appropriate information, member name or id number.
  • Claim Information
    • - Claim Type, you'll need to select the appropriate claim you're searching for either HCFA or UB92 claim.
  • From and To dates - enter a date range
  • Search for Claims
To look up another claim, click on Inquiry as you did before and follow the same steps.
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How do I get login access to the CMFHP website?

Since this is a secured area, you will need to contact your Provider Relations Representative to get access to view this information. Your Provider Relations Representative will provide you with password and login identification. Please remember to notify your Provider Relations Representative of changes in your staffing that may affect access, such as an employee leaving.
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What do I do if my website log on ID or password is no longer working?

If the message you receive is that your password has expired, contact Customer Service and they will re-active it for you. Any other issues, please contact your provider relations representative.
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How frequently is eligibility information updated on the website?

Eligibility information is updated daily.
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How frequently is claims information updated on the website?

Claims information is live data.
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Who is my Provider Relations Representative?

Click here for a list of representatives.
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How can MO HealthNet recipients switch to CMFHP?

MO HealthNet Managed Care recipients may only switch health plans during open enrollment or in cases of medical necessity. Open enrollment dates and additional information may be obtained by calling the MO HealthNet Help Line at 1-800-348-6627.
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Can we bill newborn charges under the temporary identification number?

Claims cannot be paid under the temporary identification number. If you bill with the temporary number, the claim(s) will be denied. Once notified, it takes the state 30 days to add members to the plan and issue and identification number. Please check with the state of CMFHP for the valid identification number under which claims need to be billed.
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Does CMFHP cover infertility treatment?

Infertility treatment is not a covered benefit under the MO HealthNet Managed Care program. If these services are provided, they will be denied and the member will be responsible for these charges.
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