For Providers

Missouri Custom is a collaborative care plan offered on behalf of MU Health Care and its affiliates available to large self-funded employer groups in Boone and Cole counties. The plan consists of the Missouri Custom provider network and care management services. 

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About Missouri Custom

What physicians are in-network?

This innovative network offers access to University of Missouri Health Care and Capital Region Medical Center providers, clinics and hospitals, clinically integrated providers and additional providers closely aligned with MU Health Care or Capital Region physicians.  

Members will have access to seven hospitals, 90 clinics and more than 1,000 physicians trained in 60-plus specialties and sub-specialties. 

Find providers

What hospitals are in-network?

  • University Hospital
  • Ellis Fischel Cancer Center
  • Women’s and Children’s Hospital
  • Capital Region Medical Center
  • Missouri Orthopaedic Institute
  • Missouri Psychiatric Center
  • Rusk Rehabilitation Center

How are members identified?

Missouri Custom members will have a member ID card that features both the Missouri Custom logo and the First Health logo. 

Mo Custom member logos

To verify member eligibility, call the number on the member’s ID card.

What if I need to refer a patient to a provider who is not in-network?

It is important that all providers and staff understand the importance of in-network referrals to patients within Missouri Custom. In-network referrals will ensure continuity of care and will also help keep out-of-pocket costs down.

Members may have a reduced benefit or no benefit at a non-network provider depending on their network tier structure. If it is determined that a particular service cannot be provided by a network provider, the referring provider or the member should complete an Out of Network Benefit Exception Form to get approval for the out-of-network service at an in-network benefit level.

Prior Authorization

What services require prior authorization?

Some of the services that require prior authorization are listed below. Please click the button labeled full list to see them all.

  • hospital admissions
  • observation
  • surgical procedures
  • durable medical equipment (DME)
  • behavioral health
  • home health care
  • high-tech imaging

Prior Authorization List

How do I request prior authorization?

  • Call 833-841-3895
  • Fax
    • 417-820-7866 for Ambulatory Precertification
    • 417-820-8946 for Admission and Concurrent Review OR Skilled Nursing
    • 417-841-5581 for Inpatient Rehabilitation

Pre-certification fax form

Inpatient Admission Notification Form

To check the status of a previously submitted prior authorization, call 833-841-3895.

Do emergency services require prior authorization?

Emergency services do not require prior authorization. However, plan notification of emergency services is required within 24 hours.

Care Management

What care management services are included in Missouri Custom?

Care management services include case management, chronic condition management, nurse on call and nurse triage, data management, utilization management, and pharmacotherapy management. The chronic conditions managed through Missouri Custom include:

  • Asthma
  • COPD
  • Diabetes
  • Heart Failure
  • Depression
  • Maternity

To make a referral to case management or chronic care management, call 833-841-3895.

Appeals

How do I request a peer-to-peer discussion?

To request a Peer-to-Peer Review of a Prior Authorization denial, call 833-841-3895.