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:

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:

Sarah Robinson

St. Louis College of Pharmacy

2016 Pharm.D. Candidate



  1. Missouri Pharmacist Care Network. Direct Care Pro. Accessed September 16th, 2015 at
  2. Missouri Board of Pharmacy. Pharmacist Application for a Certificate of Medication Therapeutic Plan Authority. Accessed September 21st, 2015 at
  3. National Plan and Provider Enumeration System. National Provider Identifier. Accessed October 5th, 2015 at
  4. Missouri Department of Social Services. Missouri Medicaid Provider Enrollment Information Guide. Accessed September 21st, 2015 at
  5. Missouri Department of Social Services. Missouri Medicaid New Provider Enrollment Application. Accessed September 21st, 2015 at
  6. Missouri Department of Social Services. MO HealthNet News Electronic Newsletters. Accessed October 5, 2015 at
  7. State of Missouri MO HealthNet Manuals. State of Missouri Pharmacy Manual. Accessed September 24th, 2015 at

Direct Care Pro- An Untapped Resource

As pharmacists, it is our professional responsibility to help our patients improve their overall IMG_4815health. We provide services such as immunizations, medication counseling, medication therapy management (MTM), smoking cessation counseling and more in addition to our dispensing role. There is another service available to pharmacists in the state of Missouri that has the potential to benefit our patients who participate in MO HealthNet (Missouri Medicaid).

Direct Care Pro (DCPro) is an MTM tool designed exclusively for patients with MO HealthNet. This program is intended to improve their health by uncovering gaps in care and decreasing the number of complications for those with comorbid conditions such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, gastroesophageal reflux disease (GERD), heart failure, hypertension, hyperlipidemia, osteoporosis, multiple sclerosis, etc.1 It encourages pharmacist collaboration with providers as it focuses on topics such as insufficient screening, medication management, gaps in care, self-care, etc. By completing these interventions, 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.

The program allows pharmacists to sit down with the patient in private and discuss how to improve their chronic health conditions. Examples of potential improvement plans include encouraging limiting salt intake and/or recommending the DASH diet in patients with hypertension or the importance of receiving a pneumonia vaccination in patients at increased risk of contracting pneumonia.

Potential DCPro interventions are identified through dispensing software as you fill prescriptions for patients who meet specific disease-based criteria. The message from DCPro comes over in the DUR field. An example of one message is “AVL DIAB INTV,” which translates to “available diabetes intervention.” The information may also be viewed by directly logging in to the DCPro website.

The next step is viewing the intervention opportunities online using CyberAccess. CyberAccess is a robust system of information obtained from paid MO HealthNet claims. It is the web portal pharmacists use for accessing DCPro as well as the portal used for many other provider based services. Once you have contacted the patient and scheduled a time to conduct the intervention, you must then reserve the intervention within the DCPro module. Once you have completed the intervention with the patient, you must complete the intervention forms within DCPro. Once the intervention is complete, DCPro auto populates an 837 claim for you to electronically submit to MO HealthNet. All these actions are required in order to receive payment for the intervention. Pharmacists may bill interventions in 15 minute increments for the services using CPT codes 99605, 99606 and 99607. Descriptions of these CPT codes are included in the MO HealthNet Pharmacy Manual.2 Currently, payment ranges from $10-20 per 15 minute interval.

In addition to submitting information via DCPro, there are very specific requirements for documentation in order to receive payment. You must keep a log of all clinical interventions which include the patient’s name, their signature, date of service for the intervention and the beginning/end time of the intervention. You should also document any other information pertinent to the intervention including the plan of treatment, evaluation(s), test(s), finding(s), results, etc. This is important as the patient’s chart must be reproducible for auditing purposes.

As with any other services pharmacists provide, there are some barriers that have the potential to disrupt completion of DCPro interventions. The primary difficulty for many is finding the time in which to perform these interventions. Use your time wisely; consider structuring your DCPro interventions like a doctor’s appointment. When a patient schedules an appointment with their physician, they contact the office’s receptionist, not the doctor themselves. When an available intervention arises, delegate the scheduling to a pharmacy intern or technician. If other pharmacy staff is properly trained on how to schedule the appointment while explaining the details of the appointment and its importance to the patient’s health, then you have achieved the first step of the DCPro intervention while continuing to perform your other daily duties like verifying medications and medication counseling.

Additionally, consider allowing a technician or intern to complete some of the initial paperwork for the intervention. This may include documenting the patient’s medical history, the medications they are taking along with the directions of administration, any allergies, the patient’s family history, reason or purpose of the initial visit, etc. These initial visit assessments contain subjective questions regarding how the patient feels and how they rate their overall health; something a technician or intern is more than capable of performing. Again, this allows you to complete some of the initial steps of the intervention while continuing to perform other important tasks.

Another way to find the time to perform these interventions is to select interventions that fit into your schedule. With DCPro, you have the ability to select which intervention to perform as well as to bill in 15 minute increments. Consider performing a short, 15 minute intervention to start with and then go from there. Bear in mind that the ultimate goal of DCPro is for the patient to improve their health and that it will take some patients different time intervals to do so.

Another barrier that may be preventing you from utilizing DCPro is that the intervention must take place in an area that is HIPAA compliant. You may think that in order to be truly HIPAA compliant, you must conduct the interventions in a room with four walls separate from your pharmacy counter. This is a barrier that is easy to overcome. Consider using a screen or a room divider in an area of your building to provide the level of privacy required to conduct DCPro interventions. This may be similar to the privacy measures put in place when administering vaccinations.

Using these tactics to overcome barriers that may be preventing you from using Direct Care Pro, I hope you feel more empowered to take advantage of this unique opportunity. DCPro not only provides an additional opportunity to receive reimbursement; it also allows us as health care professionals to expand clinical knowledge to the benefit of our patients. Be confident in the value of services we provide as pharmacists. By completing DCPro interventions and utilizing other medication therapy services, you are advancing the pharmacy profession one patient at a time.

Next week’s blog will focus on how to meet the requirements for performing DCPro interventions, including how to apply for a certificate of medication therapeutic authority and becoming a MO HealthNet (Missouri Medicaid) provider.

Sarah Robinson

St. Louis College of Pharmacy

2016 PharmD Candidate


  1. Missouri Pharmacist Care Network. Direct Care Pro. Accessed September 16th, 2015 at
  2. State of Missouri MO HealthNet Manuals. State of Missouri Pharmacy Manual. Accessed September 24th, 2015 at

Starting my Rotation with a Bang: The 2015 Mid-America Pharmacy Conference & Expo

IMG_4813I had the pleasure of attending the 2015 Mid-America Pharmacy Conference and Expo right at the start of my rotation.

My first experience at this rotation was attending a board meeting of the Missouri Pharmacy Association. It was the first board meeting I had ever attended of any association. Members of the board discussed important pharmacy issues such as how to approach the topic of biosimilar drugs, making changes to the bylaws, planning for future MPA conferences, etc. It was interesting to see the behind the scenes action of how the MPA works to make the pharmacy profession better for Missouri pharmacists.

I was also able to witness how hard the MPA, KPhA, and OPhA worked to make the conference such a success. I also had the pleasure to help these individuals during the conference, which was very rewarding. One particular task I had was helping out pharmacists with the conference app on their phones. Rather than distributing printed copies of sign in sheets and evaluation forms, all the material was available on the app, including the presenters’ PowerPoint slides. This was very helpful, but could be confusing if you weren’t familiar with the technology.

When I wasn’t helping out, I was able to attend continuing education sessions, the expo, and other conference activities such as the Gala. This provided numerous opportunities to network with pharmacy professionals from Missouri, Kansas and Oklahoma. Throughout pharmacy school, my professors have repeatedly stated how pharmacy is such a small world. This was evident in my experience at the conference. During the board meeting dinner I sat next to a board member whose daughter had been my IPPE student mentor my first semester of pharmacy school. Another board member was a pharmacist with whom I had interviewed for a job with years ago. Yet another board member I had just recently met at the most recent Missouri Legislative Day as he mentored the pharmacy students at my table on how to advocate to our legislators. I also had the pleasure to witness my preceptor from two rotations prior receive the prestigious Bowl of Hygeia award.

The most important thing I took away from this conference is best summed up in the quote MPA’s CEO Ron Fitzwater often uses “if you’re not at the table, you’re on the menu.” This is meant to demonstrate how important it is to be active in the association. If you are not involved in shaping discussion of the issues that will affect the field long-term, you run the risk of being left behind as a professional in the field. By being active in the MPA and contributing to its committees, you have the opportunity to ensure that your voice is heard and your professional opinions considered by those in a position to shape policy that will impact the field of pharmacy for years to come.

Sarah Robinson

St. Louis College of Pharmacy

2016 PharmD Candidate

Show-Me Echo 2015

Project ECHO is revolutionizing the way healthcare professionals interact and share knowledge and information. But what is ECHO? As a pharmacy student, I had never heard of the term before, except for IMG_4647phantom copy-cat that mimics you in canons and caverns. This ECHO, or Extension for Community Healthcare Outcomes, has its roots in Albuquerque at the University of New Mexico (UNM). It was initially created in 2003 by a liver specialist named Sanjeev Arora, M.D., for the purpose of expanding the availability of hepatitis C treatment.1 Thanks to the ECHO project, specialized medical knowledge is made more easily available to underserved rural areas that have limited medical resources. Specialists in their respective fields serve as mentors and colleagues as they share their knowledge and experiences with other health care professionals. Video conferencing provides a secure link to primary care clinics within UNM’s School of Medicine. This helps keep rural clinicians current with advances in chronic disease treatment and provides continuing medical education (CME) credit.

As of December 2014, Project ECHO connected more than 20 partner clinics within the state of New Mexico alone, including prisons, public health departments, Indian Health Service sites, community health centers, and rural primary health practices sites around New Mexico. Currently, ECHO is expanding to cover a wide variety of conditions and chronic diseases including mental health, substance abuse, gestational diabetes, and rheumatologic diseases.2 The project has spread to 22 states and five countries outside the United States. 1

The Show-Me ECHO program kicked off in Missouri in 2014 with an initial focus on chronic pain management followed by a program focused on autism treatment. In the month of July 2015, Missouri became the first state to receive state funding for the implementation of Project ECHO with support from legislator and Governor Jay Nixon. The funding, totaling $1.5 million, will allow the establishment of four new ECHO focus areas: endocrinology, dermatology, hepatitis C, and childhood asthma.3 It will additionally help fund the ongoing, original ECHO programs of autism and chronic pain. The Show-Me ECHO program’s goal is “To use videoconferencing technology to provide education, training, and engagement opportunities to primary care providers concerning specific disease states or conditions that are chronic, costly, common, and complex to improve patient access and health outcomes as well as reduce overall cost for care of patients.”4 The program focuses on disease states that are “common but complex, chronic and costly.”5

On August 12th, 2015 I attended the Missouri Telehealth Network’s Show-Me EHCO Expert Panel Kick Off at the University of Missouri in Columbia. The conference covered the past year in regards to the ECHO program. The obstacles that were overcome to get the project off the ground and the success the chronic pain ECHO has seen thus far were discussed. The Chronic Pain ECHO began on November 6th, 2014. Today there are 2,024 people participating in the clinic, according to Richard Lillard, PsyD. The program boasts an integrative approach that depends on active participation for success.

The new chronic management disease ECHO groups that will be piloted this year in Missouri met with the expert panels and discussed their goals and anticipated start up dates and clinic times. In particular, the ECHO Autism program started in March of 2015. Dr. Sohl, an Autism ECHO facilitator, reports that their expert panel not only contains expert healthcare professionals but also a parent with an autistic child so that the panel can have a unique perspective on treatment and how it affects the family and patient outside of the office. She also states that of the children who are examined, less than half of this population are actually diagnosed with autism. The sheer volume of patients that the clinic has to sort through sets them back months and takes time away from the families and children who truly need counseling and guidance for their autism. If primary care physicians could be educated on how to properly identify and diagnose this disease, then physicians like Dr. Sohl, would have more time to focus on those who need her special set of skills and knowledge.

On August 13th, 2015, I attended the Show-Me Chronic Pain ECHO training at the Missouri Primary Care Association (MPCA). Dr. Karl Haake presented concerning the state of chronic pain in Missouri and the challenges primary care physicians face. During this presentation, the fact that Missouri is the only state without a drug monitoring program was highlighted. Patients from surrounding states prey upon Missouri for their opioid prescription drugs and the lack of drug monitoring lets opioid abuse run rampant. Missouri has the 7th highest drug abuse rate in the United States. The distinction was made between the treatment of chronic pain and the treatment of addiction. When approaching chronic pain treatment, it is important that both the physician and patient know that “no one can be 100% pain-free.” Reducing pain to a tolerable level where patients can perform certain daily functions is a more realistic goal.

As a future pharmacist, this presentation made me excited to learn more about chronic pain and ways that I can help decrease the amount of opioid abuse within our state while also providing alternative solutions to patients. I also learned more about alternative treatment options for this disease. Listening to specialists speak about their own experiences gave me more insight into chronic pain than four years of school ever could. Dr. Haake described how his opioid pain clinic worked to control chronic pain without opioid use even if it meant making the difficult decision of sending the patient through withdrawal. Each patient is diagnosed on an individual basis and treatment is continually modified to ensure that the patient is being adherent and that the dose is appropriate, which may include decreasing to lower dosages instead of adding newer analgesics to mask the underlying problem.

I was further intrigued by the myriad of healthcare professionals that made up the Chronic Pain ECHO Clinic, along with the new ECHO clinics emerging this year. Pharmacists, physicians, behavioral health providers, and administrative personnel all come together to ensure the program’s success. Active participation between the expert panel and the primary care providers is crucial within ECHO. ECHO enables the sharing of knowledge between specialists and primary care providers allowing patients to stay within their local communities, thereby increasing the number of patients that will receive treatment and improving overall access to care. With such common and costly disease states, providing specialty knowledge to outlying areas creates ease of access to knowledge while also ensuring quality care.

The disease states that ECHO focuses on are complex in their treatment guidelines. Treating pain, psychological and behavioral diseases requires a different approach than when treating a patient with hypertension or chronic cardiovascular disease. The disease states currently covered by the ECHO program are monitored using more subjective measures than those conditions that may have more objective measures such as heart failure. A patient cannot be weighed and measured to determine the progression of chronic pain. The diagnosis and treatment is based upon the patient’s description and treatment is determined at the physician’s discretion. By communicating with a diverse panel of qualified professionals, providers are able to collaborate with specialists and make more informed decisions for their patients.

I believe it is imperative that pharmacists participate in programs such as the ECHO project. Pharmacists provide a unique outlook on patient care and can provide insight on medication administration, compatibility, and adherence that other primary care professionals may fall short on. The field of pharmacy is transforming and is focusing on patient centered care. It only makes sense that pharmacists become familiar with all aspects of patient care and share their knowledge to help decrease adverse drug reactions, prevent hospital readmissions, and ensure patients receive the best possible care. The ECHO program creates an opportunity for primary care providers to interact and learn from one another in a way that is normally not possible in their respective settings.

If you have any questions about the Show-Me Echo project or want to get involved, you can contact Rachel Mutrux, the senior program director at the Missouri Telehealth Network, at or by calling her at 573-884-7958.

Kenna Marx

UMKC School of Pharmacy in Columbia

Pharm.D. Candidate 2016

  1. UNM School of Medicine. Project ECHO. Accessed August 14th, 2015.
  2. Health IT. PROJECT ECHO: Bringing Specialty Care to Rural New Mexico. Accessed August 18th, 2015 at
  3. Heartland Telehealth Resource Center. Missouri telehealth project lands state funding. Accessed August 19th, 2015 at
  4. Missouri Telehealth Network. Show Me ECHO. Accessed August 18th, 2015.
  5. Edison K, MD. University of Missouri Health Systems. State Funding Gives Providers Access to Telehealth Training for Chronic Diseases. Accessed August 19th, 2015 at


Emergency Medication Dispensing for Schools

It’s that time of year again. School is back in session. Students and their parents are crowding pharmacies to fill their IMG_4652medications. Extra bottles and labels are provided for daytime doses at the nurse’s office. Students aren’t the only ones approaching the pharmacy counter. School nurses themselves are preparing for school at the pharmacy asking to fill prescriptions for emergency asthma and anaphylaxis medications to be held on hand at the school.

The Issue:

Pharmacies have been receiving fill requests from school districts to fill albuterol inhalers and epinephrine pens for office use. These requests have been denied by some pharmacists which is causing frustration and confusion within the school district and among the nurses. Pharmacies seem to be worried that a drug distributor’s permit is required to legally dispense these medications. Due to the widespread confusion, multiple calls have been made to the Department of Health supporting the school nurses and inquiring how they can appropriately attain the necessary emergency medications to prepare for the school year.


The Board of Pharmacy and the relevant state legislation dictate that it is appropriate for a school nurse to maintain a supply of albuterol and epinephrine syringes at school. The nurse must be employed by the school district and they must be properly licensed as a nurse under chapter 335. To properly obtain the previously mentioned emergency medications, a prescription written by a licensed physician, physician’s assistant, or nurse practitioner is required. The school district must be designated as the patient on the prescription and the nurse’s name must be included. The prescription may be filled at a licensed pharmacy without additional licensures or certifications.

The prescription shall be treated as any other authorized prescription that is brought into the pharmacy as long as it is has the appropriate information. There are no additional statues or regulations regarding this law. The Board of Pharmacy assures that no other documentation is required. For further information regarding legislation, please refer to sources cited below.

Kenna Marx

UMKC School of Pharmacy in Columbia

Pharm.D. Candidate 2016

References: House Bill No. 1188. Accessed August 25th, 2015 at Missouri Revised Statutes. Accessed August 25th, 2015 at

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