Missouri bill requires health plans and pharmacy managers to answer state inquiries within 60 days on MO HealthNet claims

Health benefit plans, third-party administrators, administrative service organizations, and pharmacy benefits managers must respond to state inquiries regarding medical assistance and MO HealthNet subrogation claims within 60 days. These entities are also prohibited from denying state-submitted claims due to a lack of prior authorization, with specific exemptions for Medicare and other plans. Furthermore, these organizations must accept state-provided coverage authorizations for individuals as valid prior authorizations.

Insurance companies and health plan administrators face a strict 60-day response window for state inquiries and lose the ability to deny claims over missing prior authorizations, affecting how state Medicaid subrogation claims are processed and reimbursed.