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Coverage Information

Prior Authorization

Sometimes your PCP is asked to call Missouri Care to get our approval to do some services. That process is called prior authorization.

If the request is approved:
  • The PCP or specialist can treat as requested
If the request is denied:
  • Missouri Care’s Medical Director will notify the provider why the request was denied
You will receive a letter from Missouri Care if a service is denied. The letter will explain why the service was denied. It will also tell you how to request an appeal of the denial.
(Please see the Grievance and Appeals section for more details about how to request an appeal.) 

Your PCP or specialist cannot bill you for denied services. If you receive a bill for denied services, please call Missouri Care at 1-800-322-6027. You may also call us if you have any questions about this process.

Member Services 

Missouri Care’s Member Services Department can tell you about any restrictions on services, including any referral or prior authorization requirements you must meet to get services from the provider

Missouri Care’s normal business hours are Monday through Friday, 8 a.m. to 5 p.m. Call 1-800-322-6027 for questions about being a Missouri Care member or to get help with the care you need. You can call this number from anywhere at no cost to you, even if you’re out of town.

You can also reach someone after our normal business hours. Missouri Care has a team who can talk to you 24 hours a day, 7 days a week. You can call if you have questions about being a Missouri Care member. You can also call if you have a question about what kind of care you need or how to get care.

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State Approved: 06/22/2016 MOC16078 Last Updated On: 6/22/2016