Becoming a Missouri Medicaid Provider

IMG_4809Last week’s blog discussed how we as pharmacists can better utilize the MTM tool of Direct Care Pro (DCPro). DCPro is designed exclusively for patients with MO HealthNet (Missouri Medicaid). DCPro encourages pharmacist collaboration with providers as it focuses on topics such as gaps in care, insufficient screening, medication management, self-care, etc. By completing these interventions, we as pharmacists are able to work closely with providers to ensure that our patients have numerous opportunities to improve their chronic health condition(s) and overall health.

There may be barriers currently preventing you from participating in DCPro such as difficulty in finding the time to perform interventions, making an area of your pharmacy HIPAA compliant, etc. Last week’s blog provides guidance and strategies to overcoming these barriers.

There are two major requirements a pharmacist must first meet in order to perform DCPro interventions. In addition to holding a certificate of medication therapeutic authority issued by the Missouri Board of Pharmacy, you must be a MO HealthNet provider in order to provide this service for your patients.1 Becoming a MO HealthNet provider can be a complicated task, if you are not familiar with the process. This blog entry will take you step by step through the process of becoming a MO HealthNet provider.

Before you can even begin the enrollment process, you must possess a certification of medication therapeutic authority issued by the Missouri Board of Pharmacy.2 If you are a Pharm.D, obtaining this certificate is quite easy as the degree itself meets the requirements of the certificate. However if you are not a Pharm.D, you must participate in a Missouri Board of Pharmacy approved Medication Therapy Services (MTS) training course before applying for the certificate. This can be any medication therapy certificate course or program accredited or granted by ACPE, ASHP, ASCP or APhA.1 In addition to the cost of the MTS training course, there is a $50 application fee for this certification. You must also obtain an NPI number prior to beginning the MO HealthNet provider process.3

Once you have received your certificate and NPI number, you may begin the application to become a MO HealthNet provider. One must enroll via Missouri Medicaid Audit and Compliance (MMAC) on MO HealthNet’s website. For the purposes of utilizing DCPro, pharmacists enroll under provider type 35, disease management.4 It is important not to confuse provider types as there is also a provider type 60 called “pharmacy” which is an institutional provider type, not an individual provider type. Additionally, there are two subsets under provider type 35: disease state management training services (to use DCPro) and diabetes self-management training services. For this reason, it important to decide upon the extent of services you wish to provide prior to completing the application.

The application for provider status is available online and may be submitted there. A caveat; it is only available using the Internet Explorer web browser! If unable to access the application online, you may request a paper application from MMAC Provider Enrollment. At this time, there is no application fee for individual providers for either the online or paper application.

For pharmacists wishing to utilize provider status solely for utilization of DCPro, you must submit a copy of your current license with the MTS designation in addition to the application. If you wish to also use your MO HealthNet provider status for diabetes education, you must submit a copy of your current license as well as a copy of your appropriate diabetes education certification form. This certification may be in the form of completion of either the NCPA “Diabetes Care Certification Program” or the APhA/AADE certification program “Pharmaceutical Care for patients with Diabetes” or be a current CDE.4

Every application for provider status is reviewed and subject to the audit process. Applications are processed in the order in which they are received. As the application itself is quite detailed and lengthy5, it is very important to double check that the information you submitted is correct and complete. If material is missing, MMAC will likely be contacting you!

If you have heard about DCPro from your colleagues, one thing you may remember about the program is how lengthy the enrollment process can be. Happily, in the past few months, the enrollment process has become much more expedited. The majority of new applications are being processed in fewer than 30 days whereas the process formerly lasted months. If this was the barrier that was keeping you from becoming a MO HealthNet provider, hesitate no more and begin the enrollment process today.

Once the enrollment process is complete, you will receive an email containing your name, address, NPI number and effective date of approval. If for some reason you have not received this email 30 days after submitting your application, reach out to the MMAC to verify the status of your application.

Upon receiving confirmation of your MO HealthNet provider status, there is still the opportunity to gain access to CyberAccess and the DCPro module. You must contact the Xerox help desk via e-mail or telephone to receive access to DCPro via CyberAccess as they are the subcontractor responsible for maintaining the web portal.1 Additionally, it may be beneficial to participate in the web-based training sessions that Xerox offers to learn how to reserve, perform and bill for DCPro encounters.

Xerox and MO HealthNet also recommend subscribing to MO HealthNet News6 in order to stay up to date on notifications such as provider bulletins, provider manual updates and other official MO HealthNet news. The provider manual for pharmacists is a very lengthy document, yielding 247 pages of details.7 Therefore it would be much easier to subscribe to the updates than to read through the manual itself periodically.

Pharmacists who have obtained MO HealthNet provider status have the unique opportunity to help our Medicaid patients improve their health utilizing Direct Care Pro. By involving and coordinating patient care utilizing the patient, their physician and their pharmacist, in addition to promoting self-care, we are ensuring that the patient has all resources available to them in order to be successful in managing their own health condition(s). It is much like the famous saying, “give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.”

For more information on Direct Care Pro, including a detailed list outlining the next steps to utilize this service, simply follow the link: http://www.mo-pcn.com/pharmacistopportunities/direct-care-pro/

If you are interesting in exploring more MTS opportunities, follow the link to the Pharmacist Service Expansion Project. This program allows pharmacists to apply for a scholarship grant to cover program participation costs for MTS, Diabetes Accreditation Standards- Practical Applications (DASPA), DSME site accreditation, and various disease-specific programming: http://www.morx.com/index.php?option=com_content&view=article&id=208:pharmacist-service-expansion-project&catid=20:site-content#.Vg1XQvlVikp

Sarah Robinson

St. Louis College of Pharmacy

2016 Pharm.D. Candidate

 

References

  1. Missouri Pharmacist Care Network. Direct Care Pro. Accessed September 16th, 2015 at http://www.mo-pcn.com/pharmacistopportunities/direct-care-pro/
  2. Missouri Board of Pharmacy. Pharmacist Application for a Certificate of Medication Therapeutic Plan Authority. Accessed September 21st, 2015 at http://pr.mo.gov/boards/pharmacy/IMTSAPP.pdf
  3. National Plan and Provider Enumeration System. National Provider Identifier. Accessed October 5th, 2015 at https://nppes.cms.hhs.gov/NPPES/Welcome.do
  4. Missouri Department of Social Services. Missouri Medicaid Provider Enrollment Information Guide. Accessed September 21st, 2015 at https://peu.momed.com/peu/momed/presentation/providerenrollmentgui/Internetman121103.htm
  5. Missouri Department of Social Services. Missouri Medicaid New Provider Enrollment Application. Accessed September 21st, 2015 at https://peu.momed.com/peu/momed/presentation/providerenrollmentgui/BaseQuestionaireWindow.jsp
  6. Missouri Department of Social Services. MO HealthNet News Electronic Newsletters. Accessed October 5, 2015 at http://dss.mo.gov/mhd/global/pages/mednewssubscribe.htm
  7. State of Missouri MO HealthNet Manuals. State of Missouri Pharmacy Manual. Accessed September 24th, 2015 at http://manuals.momed.com/collections/collection_pha/print.pdf

Tweet with @TheMPA