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Submissions for Participants Identified as John or Jane Doe

Providers who admit or render services to a MO HealthNet Managed Care health plan participant who is initially identified as a John or Jane Doe, or who does not disclose their MO HealthNet coverage at the time of service, should contact the respective health plan as soon as the member’s identity and insurance information becomes known. 

When requesting authorization in these situations, please include the following in your submission:

  • At the top of the authorization request, clearly explain why the request could not be submitted timely and specify the extenuating circumstances
  • Provide all documentation showing attempts to obtain the member’s identification insurance information from the member or family of the member
  • Provide documentation related to services that were initially authorized by another payer who later determined the member was ineligible at the time of service, including any denial information
  • Provide documentation of any attempts to contact the health plan during the period services were rendered

Contact information for each Managed Care health plan is located on the Provider Information page. For questions, contact Provider Communications via eMOMED or by calling (833) 222-7916.