Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. There are three different programs that makeup the Statewide Medicaid Managed Care Managed Medical Assistance (MMA) Program, Long-term Care (LTC) Program, and Dental Program Learn More About MMA and LTC Learn More About Dental Default Pay Multiple Service Locations, Attending Please contact the Public Records office for questions about the public records requests. 0000018945 00000 n A new application must be submitted if the ATN was terminated before March 2022. Additional information can be found in the NLC Quick Reference Guide (QRG), located in the Add Additional Locations section of the Enrollment Forms page. Effective March 8, 2022, the following CARC/RARC combinations will pay and post on qualifying X12 837 encounters via 835 transactions: REFERRING DETAIL ZIP CODE IS MISSING/ 7:30 AM - 6 PM ET. Sunshine Health is a managed care plan with a Florida Medicaid contract. 0000024293 00000 n Florida Department of Health | Division of Medical Quality Assurance Search Services, To verify a Nurse Licensure Compact Multi-State RN or LPN License, access. 0000026201 00000 n If you are a provider meeting the criteria above and currently have an Application Tracking Number (ATN), AHCAs Provider Enrollment team will assist you in completing the process. Any provider that has a payment suspension based on a credible allegation of fraud within the last 10 years,[23] Any provider excluded within the past 10 years by HHS-OIG or an SMA,[24, 25] Any provider that has a qualifying Medicaid overpayment,[ 26] The provider is enrolling within 6 months of the date of the lifting of a <>/Metadata 210 0 R/ViewerPreferences 211 0 R>> NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. endstream endobj startxref Sign in with your Florida Medicaid account (use new password if you recently completed a reset). The PML and PPL revised layouts will accommodate the new NPI Mapping Logic, which will be implemented on March 1st, 2022. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. The benefit information provided is a brief summary, not a complete description of benefits. hb```f``f`a`,gf@ a+P dk3~Gx0m`c``v[@q4#RrhUn 1 (sHslFi\X If the provider is not a fully enrolled provider (noted with "Y" under Registered Provider Column on Provider Master List) please contact WellCare at: 1-866-334- These enhancements will be available to Fully enrolled, Limited enrolled, and ROPA enrolled providers. Share sensitive information only on official, secure websites. To verify a Nurse Licensure Compact Multi-State RN or LPN License, access NURSYS License Number Enter License Prefix and License Number with no spaces, leading zeros or colons. We recommend you use a certified browser to ensure that the application functions as expected. Effective February 25, 2022, the following self-service features will be available: NPI Self-Service: The new NPI self-service feature will allow providers to update or add a new NPI to the Medicaid provider ID associated to the account the provider is logged into. The agency will be posting related updates to X12 837 companion guides soon. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS 0000019074 00000 n Questions? If the provider is a fully enrolled Medicaid provider (noted with "N" under Registered Provider column on Provider Master List) please contact AHCA at: 1-800-289-7799 Option 4. ii. Complete Enrollment for Your Medicaid ID. 49 0 obj <> endobj xref Medicaid Provider Directory - Region 3 (PDF) Serving Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union counties Medicaid Provider Directory - Region 4 (PDF) Serving Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. Claims and encounters passed whenever a one-to-one match was found. Email Us. INVALID, REFERRING SERVICE ADDRESS IS INVALID- 0000063950 00000 n r>LFoc6rw,0-ccIp3@IqusJ. endstream endobj startxref The table below presents the most recent, point-in-time count of total Medicaid and CHIP enrollment in for the last day of the indicated month, and is not solely a count of those newly enrolled during the reporting period. NPI - National Provider Identifier. 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). TIN - Tax ID Number . Claim submissions . The type and amount of services depends on the age of the beneficiary, the type of Medicaid program in which the beneficiary is enrolled, and the type of services determined medically necessary by the beneficiary's Primary Care Provider. Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, How to Create Positive New Habits in our New World, Statewide Medicaid Managed Care Registered Provider Initiative form (PDF), medicaideligibilityoutreach@ahca.myflorida.com, Call 1-800-289-7799, Option 4 for any additional provider enrollment questions. 0000022399 00000 n The Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. Closure, 835 | Florida Medicaid Web Portal (flmmis.com), healthplan.support@gainwelltechnologies.com, Medicaid Provider Minimum Wage Requirements page, Florida Medicaid Agency for Health Care Administration, Florida Medicaid Health Information Network, Florida Medicaid Health Care Alerts Subscription, Centers for Medicare and Medicaid Services (CMS), Florida Health Finder - Consumer Information, You are using a browser that does not support the features required for use with this web application (JavaScript not enabled). Only eligible enrolled Organizational (Group) providers operating under the same Federal Employer Identification Number (FEIN/Tax ID), may enroll additional service locations. Toll Free: (877) 423-4746. Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status hmo6 Community Care Plan is owned by South Florida's most experienced names in health care: Broward Health (North Broward Hospital District) and Memorial Healthcare System (South Broward Hospital District). Fort Lauderdale, Florida. trailer <<9525EF5C7FA24921844CA5259BD404D3>]/Prev 78233/XRefStm 1251>> startxref 0 %%EOF 85 0 obj <>stream The Florida Medicaid Web Portal supports the Microsoft Edge Chromium browser which can be downloaded from the Microsoft website. On February 2, 2022, the Agency for Health Care Administration (Agency), along with its fiscal agent Gainwell Technologies (Gainwell), sent an alert informing health plans of new CARC/RARC combinations that will post and deny on Health Plans 835 transactions containing encounters. Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. Florida Medicaid. ? YM}O}H-~u.:t `'m@#q# t3>:khAC^Qdb.KktxU#\^Xuv=5 Provider Information Reports The Agency for Health Care Administration (Agency) provides three reports of provider data, the Provider Master List, the Pending Provider List, and the Denied Provider List. 826 0 obj <>stream %PDF-1.7 We update the Code List to conform to the most recent publications of CPT and HCPCS . We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. 0000011496 00000 n COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. | Illinois Fingerprint Vendor Agency (license # 262.000016) 4 0 obj 0000015958 00000 n To distribute the funds appropriated for the Medicaid provider minimum wage requirement, AHCA has been directed to increase Medicaid managed care reimbursement rates and certain Medicaid fee-for-service fee schedules. Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. Registered providers enrolled as provider type 97 MANAGED CARE TREATING PROVIDER - NON-MEDICAID. <> %%EOF Providers can access this information on the Enrollment Status page under the Provider Services tab. 0000025810 00000 n An updated Provider Master List tip sheet is now available on the Managed Care Support section of the Florida Medicaid Web Portal that details the changes. The Freedom First Budget provided over $600 million in funding to the Agency for Health Care Administration (Agency or AHCA) for the sole purpose of increasing the minimum wage for employees of Medicaid providers to at least $15.00 an hour. You also have to meet Nursing Facility level of care. The new NPI to Medicaid ID Search Engine tool displays an indicator to identify the Medicaid ID/service location that the NPI mapping logic will default to when there are multiple identical service locations for a single NPI. Example: ME99999 or ME069999. E I IW42@ Va~(i&^ L ,d(SJ{K"K7(52jT^FT,48P$1XT4k8e. AHCA requirements 0000063183 00000 n 0000041995 00000 n 49 37 Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. 268 0 obj <> endobj Completed and signed attestations can be submitted by the physician to the Department of Health via secure email at CMS.ClinicalEligibilityScreening@flhealth.gov or via fax to 850-488-3813. 2023 UnitedHealthcare | All Rights Reserved, Florida Medicaid: Claim and AHCA data must match, Sign in to the UnitedHealthcare Provider Portal, Health plans, policies, protocols and guides, The UnitedHealthcare Provider Portal resources, Verify your provider enrollment information as it appears on file with AHCA. The following essential providers are part of Sunshine Healths network and are available to all members: You will need Adobe Reader to open PDFs on this site. In order for your Medicaid ID to remain active, you must update your enrollment type to Enrolled or Limited Enrollment by the PML expiration date. The Managed Care pages provide managed care plans with helpful information and tools related to fiscal agent file exchange, guidance for understanding data, and reports. _b>? Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. The Enrollment Tracking Search feature has been updated to include application deficiency reasons. The Florida Medicaid Taxonomy Guide, found under Enrollment Forms on the Florida Medicaid Web Portal, open_in_new identifies taxonomies that correlate to provider types and specialties FLMMIS Provider Enrollment open_in_new lists provider types Claims, Billing and Payments on UnitedHealthcare Provider Portal to review and resubmit claims Questions? Several of these new CARC/RARC combinations have been revised and will no longer cause a denial on encounter submissions. 0000048276 00000 n Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved 0 endobj For more information contact the Managed Care Plan. Revised CMS-1500 Claim Form (front . Florida Medicaid will pay for medically necessary services provided to recipients diagnosed with COVID-19, regardless of whether the provider is located in-state or out-of-state. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. The Master List serves as a library of Fee-for-Service DMEPOS codes that were flagged as potential vulnerabilities based on the criteria outlined in CMS-1713-F. As of April 13, 2022, the Master List includes 439 items. Find a Provider For Members For Providers Get Insured Coronavirus Information For Providers Value-Based Incentive Programs Billing and Claims Utilization Management Coronavirus Information Become a Provider Contact Us Eligibility Verification Login Pharmacy Pre-Auth Check Provider News Provider Resources Provider Complaints Assessment Tools Providers and suppliers dont need to take action unless an item on the Master List also appears on one or both Required Lists: The Required Lists Comparison Chart (PDF) is a side-by-side crosswalk of both Required Lists. 0000001572 00000 n Default Pay Multiple Service Locations, Performing PLEASE CHECK SPELLING, SPACING. By using this site, you agree to the 0 Heres how you know. 0000020302 00000 n Detail Default Pay Multiple Service Locations, Ordering