All rights reserved. See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. post on health plan encounter submissions. PLEASE CHECK SPELLING, SPACING. Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. | r]G(c>|2]eVg\PP The agency will be posting related updates to X12 837 companion guides soon. Responsible for assisting plans and providers with the provider enrollment process, both initial and renewal; submitting provider maintenance to the Medicaid fiscal agent; receiving, tracking, and monitoring escalated issues, legislative requests, and public records requests; performing onsite reviews; coordinating and delivering plan and This enhancement replaces the New Service Type or Address Request form that is currently used to request a secondary location. 0000014536 00000 n
AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. 0000020302 00000 n
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. For more information on the supplemental wage agreement and fee schedule increases related to the minimum wage requirements, please visit the Agencys Medicaid Provider Minimum Wage Requirements page on the Agencys website or visit the Supplemental Wage Agreement page under Agency initiatives on the public Web Portal. Florida ORI Numbers and Professions - Accurate Biometrics The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. E I IW42@ Va~(i&^
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The Agency for Health Care Administration (Agency) and its fiscal agent, Gainwell Technologies, would like to notify providers of upcoming enhancements to the Florida Medicaid secure Web Portal. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. hbbd```b``A$"Y
&$3&8d SIt+ The Agency for Health Care Administration (Agency) and the Agency's fiscal agent, Gainwell Technologies (Gainwell), have enacted the NPI Crosswalk Elimination initiative to mitigate NPI Crosswalk data issues. means youve safely connected to the .gov website. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. Only eligible enrolled Organizational (Group) providers operating under the same Federal Employer Identification Number (FEIN/Tax ID), may enroll additional service locations. 2 Default Pay Multiple Service Locations, Facility
.gov Master List of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items Potentially Subject to Conditions of Payment CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. AHCA Find Medicaid Doctors, Dentists, and Specialists Find Medicaid Doctors, Dentists, and Specialists "To find doctors, dentists, and specialists in your community that serve Medicaid patients, go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a Choice Counselor." Search Providers | Florida Department of Health Home Programs & Services Infant, Child & Adolescent Health CMS Managed Care Plan Search Providers Search Providers CMS Plan 850-245-4200 CMSPlan@flhealth.gov Mailing Address Office of the CMS Managed Care Plan 4052 Bald Cypress Way, Bin A06 Tallahassee, FL 32399 If your Medicaid ID shows an enrollment type of Registered status on AHCAs Provider Master List (PML), claims received under your NPI will deny for Medicaid ineligibility. Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. Provider Links - Florida %PDF-1.7
Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . 0000026201 00000 n
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The benefit information provided is a brief summary, not a complete description of benefits. hbbbd`b``* /
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Search Providers | Florida Department of Health Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. Health plans can access the sample test files with the new layout on the Submission Information page of the Florida Medicaid Web Portal. Beginning March 1, 2022, an enhancement will be applied to the NPI Mapping Logic which will affect providers and health plans who submit claims and/or encounters to Florida Medicaid. 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. Additional information can be found in the NLC Quick Reference Guide (QRG), located in the Add Additional Locations section of the Enrollment Forms page. The PML and PPL revised layouts will accommodate the new NPI Mapping Logic, which will be implemented on March 1st, 2022. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 0000063432 00000 n
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Please review the Known Issues and Informational Items List for details listed related to the MMIS. As part of the Registered Provider Enrollment Initiative, the Agency for Health Care Administration (AHCA) is offering enrollment assistance to Skilled Nursing Facilities, Assisted Living Facilities (ALFs) and Residential and Freestanding Psychiatric Facilities that are actively seeking compliance with the Registered Provider Initiative. PDF FL Medicaid Reference Guide The Agency is also required to enter into a supplemental wage agreement with each impacted Medicaid Provider by October 1, 2022, to ensure compliance with the minimum wage requirements. 0000041273 00000 n
A new application must be submitted if the ATN was terminated before March 2022. Download the free version of Adobe Reader. endstream
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<. AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. (cont. Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims 0
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. Child Welfare Provider Directory - Region 3 (PDF) Serving Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union counties Child Welfare Provider Directory - Region 4 (PDF) Serving Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties %PDF-1.6
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Use the following chart to know whats needed to correct your claim based on the remittance denial code and go to our Claims Interactive Guide for instructions on how to submit a claim correction. lock Download the free version of Adobe Reader. Steps to getting contracted plus plan information, Phone numbers and links for connecting with us, List of contracted, high-quality independent lab providers, Update, verify and attest to your practice's demographic data, Provider search for doctors, clinics and facilities, plus dental and behavioral health, Policies for most plan types, plus protocols, guidelines and credentialing information, Specifically for Commercial and Medicare Advantage (MA) products, Pharmacy resources, tools, and references, Updates and getting started with our range of tools and programs, Reports and programs for operational efficiency and member support, Resources and support to prepare for and deliver care by telehealth, Tools, references and guides for supporting your practice, Log in for our suite of tools to assist you in caring for your patients.