Running a Missouri Medicaid home care agency isn’t for the faint of heart. Between EMOMED, Managed Care Organizations (MCOs), EVV rules, and changing authorization policies, most agencies feel like they’re navigating a moving target.
But some agencies are thriving. They're reducing denials, staying audit-ready, and freeing up staff time instead of chasing paperwork. What do they know that others don’t?
Below are seven practical best practices from top Missouri providers that keep operations compliant, efficient, and profitable.
Missouri only pays claims that exist in Sandata.
Even if your billing system shows the visit as approved, it must be validated in Sandata or it will not pay.
Winning agencies:
Ensure visits flow into Sandata with the correct codes and units
Validate Sandata status before submitting claims
Avoid manual closing and re-keying tasks
If you’re still downloading CSVs or typing in exception codes by hand, that’s not integration - that’s unpaid overtime and error risk.
Missouri used to authorize services assuming 31 days every month.
Now authorizations match the actual number of days in the month.
This means:
February authorizations are smaller
30-day vs 31-day months matter
You must monitor authorized units more closely
Top agencies automate:
Real-time tracking of units used and remaining
Alerts when clients approach limits
This prevents under-utilization and avoids surprise denials.
The rules say that you need to use all of your CDS units first before transitioning to ILW.
High-performing agencies make this happen automatically.
They use:
A link between their CDS and ILW authorization
Automatically splitting the visit on the day when their CDS runs out and ILW starts
The result: Eliminates the manual splitting that most agencies do
For clients receiving multiple in-home services in one visit (e.g., personal care + respite services), the cleanest approach is one EVV clock-in/out and automated service splitting.
Benefits include:
Reduced visit rejections for overlapping punches or missing tasks
Cleaner EVV data and faster payroll/billing
It’s compliant and protects staff time and client satisfaction.
Missouri only pays for completed 15-minute units, but leftover minutes don’t vanish — they accumulate.
Smart agencies:
Track minutes at the client and caregiver level
Automatically convert accrued minutes into billable units
Prevent losing reimbursable time
Accurate minute tracking protects revenue and avoids overbilling.
Missouri agencies often bill:
eMOMED
Multiple MCOs like Healthy Blue and Home State
VA programs
Private pay
Each payer has its own codes, rate rules, and modifiers.
Agencies that succeed establish relationships with all of the payers, but run one billing workflow across all payers, not separate processes.
This reduces:
Duplicate entry
Configuration mistakes
Processing time and denials
More payers + One process = cleaner claims and more cash flow.
Submitting files isn’t the finish line — it’s the midpoint.
Top agencies:
Fixing issues upstream means you don’t chase denials downstream.
Missouri Medicaid requirements aren’t getting simpler, but your operations can.
By investing in:
Clean EVV-to-billing workflows
Automated authorization and unit monitoring
Unified payer billing
Proactive visit validation
Agencies gain time, reduce compliance stress, and get paid for every earned unit.
Want to see how these practices look in action? Download our free guide with workflows, checklists, and examples you can use today:
👉 Download the Missouri Medicaid Best Practices Guide
Ankota's mission is to enable the Heroes who keep older and disabled people living at home to focus on care because we take care of the tech. If you need software for home care, EVV, I/DD Services, Self-Direction FMS, Adult Day Care centers, or Caregiver Recruiting, please Contact Ankota.