Missouri
Medical Billing Services in Missouri
Medical billing in Missouri at 4-8% of collections, with credentialing as well and no long-term contract. MO HealthNet, Medicare and commercial billing for Kansas City, St. Louis, Springfield and statewide.
Key takeaways
- 01MO HealthNet requires claims within 12 months of the date of service, with 24 months the outer limit for resubmitting a timely-filed denied claim or adjusting a paid one (13 CSR 70-3.100).
- 02MO HealthNet managed care runs through three plans: Healthy Blue, Home State Health and UnitedHealthcare.
- 03Missouri requires clean claims paid or denied within 45 days, after which interest of 1% a month and a daily penalty apply (RSMo 376.383).
- 04Both Missouri metros straddle state lines, so practices routinely bill plans regulated by Illinois or Kansas.
Why Practices in Missouri Trust Our Billing
Missouri Payer Billing
Billing for MO HealthNet and Missouri's commercial payers, under each payer's own rules
Coders Matched to Your Specialty
Coding handled by people who know your services and how payers treat them
Dedicated Account Manager
Someone who knows your practice, your payers and your open claims
No Long-Term Contract
You pay 4-8% of collections, with no long-term contract to sign
What Practices in Missouri Win by Switching
MO HealthNet Billing. Billing for Healthy Blue, Home State Health and UnitedHealthcare under MO HealthNet
HIPAA Compliant. Patient data handled under HIPAA, and one dedicated account manager as your contact
See How Much Revenue Your Missouri Practice Is Leaving on the Table
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Serving Practices Across Missouri End to End
St. Louis Metro
St. Louis is a major healthcare hub, home to Barnes-Jewish Hospital and Washington University, SSM Health and Mercy. The metro straddles Missouri and Illinois, so practices often bill Illinois Medicaid and commercial plans alongside Missouri programs.
Washington University School of Medicine's academic network shapes referral patterns across the St. Louis market.
Oncology / cardiology / orthopedics / neurology / transplant medicine
Kansas City Metro
The Kansas City metro spans Missouri and Kansas, with Saint Luke's Health System, The University of Kansas Health System, HCA Midwest Health and Children's Mercy Kansas City serving patients from both states. Practices regularly enroll and bill with both MO HealthNet and KanCare.
Blue Cross and Blue Shield of Kansas City is a regional payer here alongside the national carriers.
Pediatrics / cardiology / primary care / orthopedics / behavioral health
Springfield & Ozarks Missouri
Springfield is Missouri's third-largest city and the healthcare hub of the Ozarks, home to Mercy Hospital Springfield and CoxHealth. Tourism, agriculture and retirees bring Medicare and MO HealthNet volume alongside employer coverage.
Springfield is a referral center for rural southwest Missouri and northwest Arkansas, so practices see patients who travel long distances for specialty care.
Primary care / cardiology / orthopedics / oncology / behavioral health
Common Questions About Getting Paid in Missouri
MO HealthNet managed care runs through Healthy Blue, Home State Health and UnitedHealthcare. Each plan has its own authorization process, enrollment and fee schedule, and MO HealthNet requires claims within 12 months of the date of service.
Missouri's surprise-billing law, RSMo 376.690 (from 2018's SB 982), protects patients from surprise bills for emergency care and unanticipated out-of-network care. The federal No Surprises Act also applies.
St. Louis borders Illinois and Kansas City borders Kansas, so practices enroll with payers in both states and bill each state's Medicaid program under its own rules. Which state's prompt-pay and surprise-billing law applies depends on where the patient's plan is regulated.
RSMo 376.383 requires insurers to pay or deny clean claims within 45 processing days. After that, interest of 1% a month and a daily penalty apply.
MO HealthNet requires claims within 12 months of the date of service, with a 24-month outer limit for resubmissions and adjustments. Under 42 CFR 424.44, a Medicare claim must be filed within 12 months of the service date. Commercial plans and KanCare plans such as Sunflower set their own limits in their contracts.
Full-Service Billing for Missouri Clinics
From eligibility checks to final payment, we handle your billing so you can focus on patients.
Claims Management. Claim submission and follow-up until each claim is paid or closed
Denial Management. Denied claims worked and appealed
Patient Billing. Clear patient statements and payment plans
Credentialing. Payer enrollment at $150 per application, per provider, usually 60 to 90 days with each payer, in our experience
Want a Second Look at Your Billing?
Get a free, no-obligation review of your practice's billing.
- Where claims are being denied, and why
- Which unpaid claims can still be recovered
- What billing would cost at 4-8% of collections
Specialties We Support Across Missouri
Mental health and therapy practices in Missouri are our main focus, and we also bill for the fields after them.
- Psychiatry
- Occupational Therapy
- ABA Therapy
- Behavioral Health
- Psychology
- Physical Therapy
- Speech Therapy
- Mental Health
- Substance Use Treatment
- Primary Care
- Cardiology
- Orthopedics
- Urgent Care
Join Missouri Providers Who Switched
Let us handle your medical billing so you can focus on patient care