Frequently Asked Questions

SHCN

Special Health Care Needs (SHCN) provides support services to eligible persons and their families who have special health care needs. SHCN contracts with service providers to obtain medical care and a ncillary services for participants enrolled in one or more bureau SHCN programs.

What is an Administrative Provider?
What is the role and responsibilities of an Administrative Provider?
What are the billing procedures?
How do I become an Administrative Provider?
What programs are available through the Special Health Care Needs?
After I submit an application, how long before I become a provider?
How do I add a specialty/program?
How do I obtain referrals?
What if I want to discontinue being a provider?
What if I have a change in name/payment mailing address/Federal Identification Number?
What is a provider review?
What is my provider number?
How do I become a Medicaid or MC+ provider?
How do I know if I am already a provider?

More Frequently Asked Questions

What is an Administrative Provider?
An Administrative Provider can either be a licensed/certified group or individual. They provide services or goods, as needed to Missouri Department of Health and Senior Services' participants.

What are the roles and responsibilities of an Administrative Provider?
Administrative Providers are responsible for hiring licensed/certified staff to provide services to SHCN participants. Providers shall comply with Department policies and procedures.

What are the billing procedures?
Participants receive an eligibility letter. Administrative Providers shall verify participants’ eligibility before providing services. The service shall be directly related to the diagnosis for which the participant is approved. SHCN reimbursement for eligible services must be accepted as payment in full. The Participant/family shall not be billed. When the participant is covered by other third-party payment sources, claims shall be filed with those payors prior to filing with SHCN. All claims shall be submitted within 60 days from the date of service to the primary insurer and/or third party payers or to SHCN when SHCN is the primary payer. When insurance or third party payers are billed prior to SHCN (e.g. SHCN is not the primary payer), the provider shall bill SHCN within 60 days of receipt of insurance and/or third party payment determination. For more information about reimbursement or billing issues, please contact the Fiscal Services Support Unit, Section of Maternal, Child and Family Health, 930 Wildwood Drive, PO Box 570, Jefferson City, MO 65102 or by telephone (573) 751-0162.

How do I become an Administrative Provider?
To become a provider, contact SHCN to request a provider packet.

What programs are available through the Special Health Care Needs?
Programs available include: Hope Program, Adult Head Injury Program, Healthy Children and Youth-Administrative Case Management, Physical Disabilities Waiver-Administrative Case Management, and Service Coordination. Providers are only enrolled for the Hope Program and Adult Head Injury Program.

After I submit an application, how long before I become a provider?
The enrollment process usually takes approximately four weeks. Administrative Providers will be notified by telephone if SHCN requires additional information. SHCN will notify all applicants in writing of their approval status.

How do I add a specialty/program?
After the initial approval, if you wish to add an additional specialty, notify SHCN in writing by letter or fax.

How do I obtain referrals?
Contact SHCN to be referred to the appropriate Regional Office. If you already know the location of your Regional Office, you may contact them directly.

What if I want to discontinue being a provider?
If you wish to discontinue services, notify SHCN in writing by letter or fax on business letterhead.

What if I have a change in name/payment mailing address/location address/Federal Identification Number?
If you have a change in name, payment mailing address, or Federal Identification Number, notify SHCN. An updated Participation Agreement for Professional Services Provider, Provider Application, Vendor Input form and Vendor ACH/EFT Application (if the provider wants payment direct deposited) will need to be completed and submitted to SHCN.

If you have a change in location address, notify SHCN in writing by letter or fax on business letterhead.

What is a provider review?
A Provider Review is conducted semi-annually to discontinue those providers that have had no activity in three years. The provider will be notified if updated information is needed or if they have been discontinued.

What is my provider number?
You may contact SHCN to obtain your provider number or you can find this number on your approval letter.

How do I become a Medicaid or MC+ provider?
Contact Department of Social Services, Division of Medical Services at: (573) 635-3559, http://dss.missouri.gov/dms/.

How do I know if I am already a provider?
Contact us.