Provider Resources
Get the tools you need to easily manage your administrative needs, and your keep your focus on the health of your patients. Use the tools and resources below to find the information you need, check member eligibility, submit claims through our secure provider portal, check if pre-authorization is necessary, see the status of a claim and more
- Home State Referral Fax Form (PDF)
- Medicaid Out of Network and Exceptions Form (PDF)
- PCP Change Form - English (PDF)
- PCP Change Form - Spanish (PDF)
- Interpreter Services Request (PDF)
- Raising Well Pediatric Obesity Personal Referral Form (PDF)
- Provider Refund Form (PDF)
- Outpatient Prior Authorization Form (PDF)
- Inpatient Prior Authorization Form (PDF)
- Ownership and Controls Disclosure Form (PDF)
- Acknowledgement of Receipt of Hysterectomy Information (PDF)
- Certification of Medical Necessity for Abortion Consent Form (PDF)
- Provider Reconsideration and Appeal Form (PDF)
- Case Management Referral Form (PDF)
- Ophthalmology Services Pre-Authorization Form (PDF)
- Sterilization Consent Form (PDF)
- Notification of Pregnancy (NOP) Submission Requirement (Effective September 2) (PDF)
- Missouri Tobacco Quitline for Patients with a Behavioral Health Condition or Substance Use Disorder who also use tobacco
- Recommended Actions Based on Blood Lead Level
- Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention (PDF)
- CDC Response to Advisory Committee on Childhood Lead Poisoning Prevention Recommendations in “Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention” (PDF)
- “Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention”. CDC 2002
- “Guidelines For the Identification and Management of Lead Exposure In Pregnant and Lactating Women” (PDF)
- Show-Me ECHO: Extending Specialty Care into Primary Care - (Extension for Community Healthcare Outcomes) uses videoconferencing technology to connect a team of interdisciplinary experts with primary care providers. The discussions with, and mentoring from, specialists help equip primary care providers to give their patients the right care, in the right place, at the right time.
- Communication Breakdown in the Outpatient Referral Process (PDF)
- Referral and Consultation Communication Between Primary Care and Specalist Physicians (PDF)
2023
- Provider Data Accuracy (PDF)
- Important Home State and NIA Notice Effective March 1, 2024 (PDF)
- PEAK Performance Wellcare Bonus 2023 (PDF)
- Social Determinants of Health Incentive Program (PDF)
- HSH Optum's Comprehensive Payment Integrity (CPI) Reviews - May 2023 (PDF)
- Medicare Prior Authorization Changes effective July 1, 2023 (PDF)
- Medicaid/MO HealthNet Redetermination (PDF)
2022
- Observation Authorization Update (PDF)
- Remote Fetal Monitoring (PDF)
- HSH Payment and Clinical Policy Update - November 2022 (PDF)
- Suicide Prevention Webinar Dec 2022 (PDF)
- Fluvention Provider Toolkit (PDF)
- Provider Newsletter 2022 (PDF)
- Home State Health and Show Me Healthy Kids Claims Basic Training (PDF)
- Update and Certify Provider Data in CMS's NPPES (PDF)
- Show Me Healthy Kids Provider FAQs (PDF)
- NIA/Home State CPT Code 74263 Eff 090122 (PDF)
- New Clinical Policies Effective 7/18/2022
- Medicare Payment Policy Update March 2022 (PDF)
Training and Education Courses are offered through our comprehensive clinical training program. It is designed to enhance the knowledge, skills and performance of healthcare professionals who empower our members to make positive health behavior changes.
We offer many courses to support continuing education for providers, enhance integrated care, and expand use of best practices. Participants can receive continuing education for some classes, and receive certificates of attendance related to certain licensing requirements.
Course participants come from all aspects of healthcare. They include behavioral healthcare providers, primary care physicians, long-term service and support providers, specialty therapy and rehabilitative service providers, and providers/stakeholders involved in the child welfare system. Their reasons for attending our workshops are as varied as the topics, and range from the practical — such as “authorizations” — to the profound — such as “culture of poverty” or “childhood traumatic grief.”
Multiple training topics explore ways for physical and behavioral health providers to coordinate services, such as integrated care, cultural competency, common psychotropic medications, positive psychology, strengths-based treatment model and motivational interviewing. In addition, we offer a workshop to explain the use of psychotropic medications in treating mental health and substance use disorders.
Our trainers have extensive knowledge in a variety of health topics, including behavioral health, speech, respiratory, occupational and physical therapy, nursing, exercise physiology, nutrition, diabetes, smoking cessation, case and utilization management, care coordination, data systems, organizational development, long-term services and supports, and child welfare. We are here to help you with information regarding our education and training workshops, all designed to support the treatment you provide our members and improve member outcomes.
- Missouri Provider Training
- Request trainings in person or via webinar
- Allwell QMB Billing Training (PDF)
- Provider Training Material
- Action Required Regarding CMS Mandatory Trainings (PDF)
- Local Community Care Coordination Program (LCCCP) Overview for Providers (PDF)
- A Physician’s Practical Guide to Culturally Competent Care
- Physician Toolkit and Curriculum (PDF)
- Risk Adjustment Coding, HEDIS, and Documentation Tips (PDF)
- HEDIS Quick Reference Guide 2022 (PDF)
- NIA Utilization Review Matrix Medicaid - 2023 (PDF)
- Medicaid Hospital Inpatient and Outpatient Billing Notification (PDF)
- RadMD Cardiac Provider Experience Workgroups 6.1.22 (PDF)
- NIA Home State Health - Wellcare by Allwell Utilization Matrix 2022 - (PDF)
- Turning Point Cardiac Surgical Program FAQs (PDF)
- Pre Auth Training Resource (PDF)
- Ears, Nose & Throat Surgery & Sleep Study Program FAQs (PDF)
- Ophthalmology Notice Quick Reference Guide (PDF)
- Transportation Services (PDF)
- Case Management Programs (PDF)
- Provider Quick Reference Guide (PDF)
- CAHPS Tip Sheet for Providers (PDF)
- EPSDT At A Glance (PDF)
- RHC Billing Guideline (PDF)
- HCY/EPSDT Preventive Visit Examples (PDF)
- NIA - High Tech Radiology - Utilization Reivew Matrix 2020 (PDF)
- MemberConnections Brochure (PDF)
- PaySpan Information Sheet (PDF)
- Transportation At-a-Glance (PDF)
Home State providers must keep accurate and complete medical records. Such records will enable providers to render the highest quality healthcare service to members. They will also enable Home State to review the quality and appropriateness of the services rendered. Home State will conduct random medical record audits as part of its QI program to monitor compliance with the medical record documentation standards linked below.
The coordination of care and services provided to members, including over/under utilization of specialists, as well as the outcome of such services also may be assessed during a medical record audit. Home State will provide written notice prior to conducting a medical record review.
- 2020 Annual Report Card (PDF)
- 2018 Annual Report Card (PDF)
- 2017 Annual Report Card (PDF)
- 2016 Annual Report Card (PDF)
- 2015 Annual Report Card (PDF)
- 2014 Annual Report Card (PDF)
- 2013 Annual Report Card (PDF)
2021
- Payment and Clinical Policy Updates Effective 4.1.2022 (PDF)
- TMS Coverage Effective 11/01/2021 (PDF)
- SCC Provider - Staff Support Webinar Description (PDF)
- Payment and Clinical Policy Update Notice (PDF)
- In Home Test Kits (PDF)
- Home State Health IQC Provider Portal Survey (PDF)
- Provider Accessibility Initiative Notice 6.30.2021 (PDF)
- Updated Coding, Payment and Clinical Policies (PDF)
- Interoperability Overview for Providers (PDF)
- COVID-19 Reinstatement Notice Medicaid (PDF)
- Prior Authorization Reminder (PDF)
- Turning Point Cardiac Surgical Program, Effective June 1, 2021 (PDF)
- New Coding, Payment and Clinical Policies Effective 6/1/2021 (PDF)
- COVID-19 Medicaid Notice of Vaccine Billing (PDF)
- High Risk Member Support Programs Available (PDF)
2020
- Telehealth Information (PDF)
- Notice of Policy Update (PDF)
- ENT and Sleep Study Program Training by Turning Point (PDF)
- ASAM Opioid Training (PDF)
- Asthma ECHO Program (PDF)
- Provider Training for Interqual Connect Prior Authorization (PDF)
- Important Notice Regarding Prior Authorization Submission (PDF)
- Policy Updates Effective 01/01/21 (PDF)
- Notice Regarding HSH Ears, Nose & Throat (ENT) Surgeries & Sleep Study (PDF)
- Provider Notice Ophthalmology (PDF)
- Important Reminder of NOP Requirement (PDF)
- COVID-19 At Risk Member Data (PDF)
- Observation Pharmacy Notice (PDF)
- FQHC Reimbursement Notice (PDF)
- New Payment and Clinical Policies Eff 100120 (PDF)
- Short Inpatient Hospital Stays (PDF)
- Provider Policy Updates (PDF)
- Behavioral Health Services for Children with Severe Trauma (PDF)
- Member Lock-In for Medical Services Program (PDF)
- Provider Portal Overview Lunch & Learn (PDF)
- Web Authorization Overview Lunch & Learn (PDF)
- NIA Coronavirus Response (PDF)
- FQHC Telehealth Press Release (PDF)
- COVID-19 Authorization Extensions (PDF)
- Register for E-News - Action Required (PDF)
- Web Portal Enhancement (PDF)
- COVID-19 Provider Notice (PDF)
- COVID-19 Extended Coverage (PDF)
- COVID-19 Provider Information (PDF)
- COVID-19 In-Home Care Guidance for Providers (PDF)
- Transportation Services (PDF)
- Wellcare Acquisition (PDF)
- Notice of Policy Change (PDF)
2019
- Model of Care Training Requirement (PDF)
- AAP Lead Testing Echo (PDF)
- Lexis Nexis Provider Notice (PDF)
- Early Elective Deliveries (EED) Provider Notice (PDF)
- DME Provider Notice (PDF)
- Turning Point Healthcare Surgical Quality and Safety Management Programs (PDF)
- Synagis Provider Letter (PDF)
- Appointment Accessibility Standards, After Hours and Wait Times (PDF)
- Turning Point Provider Notification Letter (PDF)
- International Overdose Awareness Day Provider Resources (PDF)
- Facility Site Selection Provider Presentation - eff: 11/1/19 (PDF)
- Facility Site Selection Notice – eff: 11/1/19 (PDF)
- Facility Site Selection Q&A – eff: 11/1/19 (PDF)
- Facility Site Selection Provider Webinar Invite (PDF)
- Notification of Pregnancy (NOP) Submission Requirement (Effective September 2) (PDF)
- We’re Moving - Clarification (PDF)
- Missouri Child Psychiatry Access Project (MO-CPAP) (PDF)
- Web Portal Redesign Provider Notice (PDF)
- Web Portal Redesign (Auths) Slide Presentation (7/1/19) (PDF)
- Lexis Nexis Payer Introduction (PDF)
- The Importance of Care Coordination (PDF)
- Important Reminders Regarding EPSDT Visits and Rural Health Clinic Billing (PDF)
- Healthy Children and Youth/Early and Periodic Screening, Diagnosis, and Treatment (HCY/EPSDT) Quick Reference Billing and Coding Guide (PDF)
- Important Information on Referral Requirement (PDF)
- Lead Tesing Provider Notice (PDF)
- Important Information Regarding Notice of Pregnancy Form Submission (PDF)
- ASAM Provider Training (PDF)
- New Roster Template Requirement (PDF)
- Physical Medicine Services Prior Auth Requirements Fax Blast (Effective June 2019) (PDF)
- Physical Medicine (PT/OT/ST) WEBINAR - (effective June 2019) (PDF)
- Physical Medicine Services FAQ Prior Authorization (effective June 2019) (PDF)
- Physical Medicine Services QRG Prior Authorization (effective June 2019) (PDF)
- Physical Medicine Services – NIA Tip Sheet/Checklist (Effective June 1 2019) (PDF)
- Important Change Regarding Independent Rural Health Clinics - Billing Requirement (PDF)
- Allwell Part B Drugs Prior Authorization Update (PDF)
- Show Me Echo Programs (PDF)
- AAP Lead Testing Webinar Announcement (PDF)
- Ambetter Teledoc Letter (PDF)
- Allwell Part B Step Therapy (PDF)
- CLIA Labs - Provider Notice (PDF)
- PCP / Specialist Communication Survey (PDF)
- Chronic Condition Coding Awareness: Supplemental Oxygen (PDF)
- 2019 Ambetter Expansion Information (PDF)
- Lexis Nexis Campaign (PDF)
- Interpreta Now Provides Daily Care Gap Reports (PDF)
- Limited Enrollment For Managed Care Network Providers (PDF)
- Behavioral Health Integration Portal Reminder (PDF)
- LexisNexis Campaign Communication (PDF)
- Opioid Potentiators Information (PDF)
- Disability Diagnosis Code Information (PDF)
- Depression Bipolar Awareness - Helpful Coding Tips (PDF)
- Action Required Regarding CMS Mandatory Trainings (PDF)
- Dental Surgery Coding and Spinal Surgery Prior Authorization Update (PDF)
- Spinal Surgery Codes - Prior Authorization Required (PDF)
- Referral Requirement, Ambulatory Surgery Optimization, and NIA Facility Selection Program (PDF)
- Lead Case Management Updates (PDF)
- Important Notice: In-Office Lab Testing and Dental Surgery Coding (PDF)
- Lexis Nexis Provider Notice (PDF)
- Provider Webinar Invitation (Post Therapy Program) (PDF)
- Notice of Pregnancy Requirement and Form (PDF)
- Local Public Health Agency Workflow (PDF)
- Jimmo v. Sebelius Slideshow (PDF)
- Clarified Summary Jimmo v. Sebelius (PDF)
- Recommendations on Medical Management of Childhood Lead Exposure and Poisoning (PDF)
- Provider Report (Reviewing the Appropriate Use of Resources) (PDF)
- CPT Code Update (PDF)
- CDC Guidelines for Prescribing Opioids for Chronic Pain Fax Blast (PDF)
- Lexis Nexis Provider Article (PDF)
- PDM Validation FAQ (PDF)
- Prenatal and Postpartum Bonus Program & Changes in Obstetrical Billing Guidelines (PDF)
- Important Change Regarding Independent Rural Health Clinics - New Billing Requirement (PDF)
- Home State IRHC Billing Update (PDF)
- Risk Adjustment Fax Blast (PDF)
- MEAT Documentation Tips (PDF)
- Important Open Enrollment Information For Providers (PDF)
- Private Duty Nursing/Personal Care Assistance (PDF)
- DME Fax Blast (PDF)
- Provider Data Pre-Audit Communication (PDF)
- Allergy EEG Urodynamic Wheelchair Seating Fax Blast (PDF)
- Provider Satisfaction Survey Fax Blast (PDF)
- Prior Authorization & Claim Edit Changes (New Genetic Testing Requirement) (PDF)
- PCP Changes Billing Updates Fax Blast (PDF)
- Clinic Billing Requirement Fax Blast (PDF)
- New Prior Authorization Appointment Standard Reminder (PDF)
- Fraud Waste and Abuse Fax Blast (PDF)
- ICD-10 FAQs (PDF)
- Dental Network Announcement (PDF)
- Radiation Safety Awareness and Lab Corp Update (PDF)
- Fax Blast Provider Demographic (PDF)
- Early Elective Deliveries Fax Blast (PDF)