Provider Appeal Change

Date: 10/14/26

Important Update: Member Consent Required for Authorization Appeals

Due to changes in the MO HealthNet Managed Care Medicaid contract, providers are now required to obtain member consent when submitting an appeal of an authorization denial on a
member’s behalf.

The appropriate appeal form is available under “Forms” on our Home State Health Member Resources webpage.

Providers continue to have the right to appeal actions taken by the health plan for the following reasons:

• The denial, in whole or in part, of payment for a service.
• A claim for reimbursement that has not been acted upon with reasonable promptness.

For additional information regarding the appeals process and provider rights, please refer to the Provider Manual available on our Missouri Provider Resources webpage.

If you have questions or need additional assistance, please contact Home State Health Provider
Services at 1-855-694-HOME (4663).