Missouri Medicaid Provider MTM Billing

Turn Your Clinical Work Into Billable Revenue

Independent pharmacies in Missouri can bill Missouri Medicaid for pharmacist clinical services through Medication Therapy Management (MTM). Most pharmacies are eligible, but very few know how to properly enroll, document, and bill.

Our programs can help your pharmacist(s) become a Missouri Medicaid Provider that allows pharmacies to successfully bill MTM services with step-by-step guidance.

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What These Programs Do

We help your pharmacy unlock new revenue from services you are already providing.

Our training and support show your team how to:

• Obtain Missouri Medicaid Provider Status
• Identify patients who qualify for MTM billing
• Document MTM encounters correctly
• Submit valid Medicaid claims
• Avoid common billing mistakes and audit issues
• Review payments and reconcile claims

We also provide real patient case examples to help your pharmacists confidently submit their first claims.

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Why Pharmacies Are Implementing This

Independent pharmacies are under significant pressure to reduce reimbursement. MTM billing enables pharmacists to generate clinical service revenue rather than relying solely on prescription margins.

Many pharmacies are missing this opportunity simply because they do not know how to set it up correctly.

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What We Provide

Our programs include:

Medicaid Provider Status application guidance
MTM documentation templates
Workflow integration for your pharmacy
Staff training and onboarding
Weekly support meetings
Claim submission guidance
Audit-safe documentation training

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Program Investment

$500 One-Time Enrollment Fee

This is for clients who currently are not established as a Missouri Medicaid Provider as a pharmacist.  You must register for the MMAC Provider Enrollment course if this is needed.

Includes:

• Reviewing current status of all pre-requisite requirements to become a provider
• Assisting in completing necessary application(s) for pre-requisite requirements
• Assisting in completing necessary application for Missouri Medicaid Provider
• Assisting in any additional requests from MMAC for Provider status throughout application

$750 One-Time Setup Fee

Includes:

• Documentation templates
• Pharmacy workflow review & planning
• Initial staff training for proper workflow
• Initial claims submissions for initial documented cases
• Claims reconciliation for submitted documented cases
• Claims corrections for submitted & denied cases

$100 Monthly Training & Support beyond initial 3 months

• Maximum 3 additional months (most pharmacies benefit from 3-6 months)
• Includes ongoing support, training, claim review, and claim reconciliation.
• Will consist of biweekly 15 minute meetings during desired months

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Time Commitment

Typical pharmacy staff time:

• 5–10 training hours per month
• 15–30 minute biweekly support meeting
• 10–15 hours during initial program setup

All training is provided remotely via online training platform alongside Zoom or other web-based meetings.

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Who This Is For

Independent Missouri pharmacies that want to:

• Increase pharmacy revenue
• Expand pharmacist clinical services
• Bill Medicaid properly and safely
• Strengthen their role as healthcare providers

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Program Timeline

Most pharmacies obtain Missouri Medicaid Provider Status in 6–12 weeks if prerequisites are already in place.

Once approved, pharmacies can begin billing MTM services immediately.  Completion of our course is easily expected to be within the first month, with cases performed and billed the second month for continued claims the third month alongside reconciliation of the second month’s claims during the third month.  With Medicaid’s financial cycle timelines, this is a very attainable goal for any store, but if extra time is needed it can be purchased on a month-to-month basis for the additional up to 3 months to work alongside staff for continued biweekly meetings to review cases and reconciliation.

This means, within the first 90 days, your pharmacy should be receiving payments for claims performed in the second month, and can continue to build the volume of cases to add in highly necessary capital for services you’re likely giving away for free now!

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Start Turning Clinical Work Into Revenue

Pharmacists already provide medication counseling and therapy management every day.

This program simply shows you how to get paid for it.