For Providers Addiction Recovery and Treatment Services, Behavioral Health, Dental, Foster Care, High Needs Support, Long Term Care, Managed Care, Maternal and Child Health, Pharmacy Services and more DMAS - Department of Medical Assistance Services Cardinal CareVirginia's Medicaid Program Department of Medical Assistance Services Menu Sitemap Use the, Verify your information matches what you submit on your claims. Claim submissions . 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. (Updated 02/15/2023). website belongs to an official government organization in the United States. This requirement also helps ensure we have the proper information needed to promptly pay your claims. r>LFoc6rw,0-ccIp3@IqusJ. View the Master List (PDF). Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. Provider. Providers can search for all Medicaid IDs associated to an NPI without having to navigate away from their secure account to use other resources to find this information. trailer <<9525EF5C7FA24921844CA5259BD404D3>]/Prev 78233/XRefStm 1251>> startxref 0 %%EOF 85 0 obj <>stream This impacted providers who had more than one state Medicaid ID. People on Medicaid will get services using one or more of these plan types: Call your provider advocate for more information. 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. To be reimbursed for services rendered to eligible Florida Medicaid recipients, providers not already enrolled in Florida Medicaid (out-of-state or in-state) must complete a provisional (temporary) enrollment application. And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. Default Pay Multiple Service Locations, Attending 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. The For more information contact the Managed Care Plan. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. Several of these new CARC/RARC combinations have been revised and will no longer cause a denial on encounter submissions. following taxonomy edits are not new but will continue to pay and (Use fewer fields to produce more results: See Search Help), Privacy Statement | For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . Privacy Policy. 786 0 obj <> endobj 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. <> 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. 0000015958 00000 n Email Advisory | Heres how you know. The QRG Page has links to the NPI Self-Service Tool QRG, Address Maintenance Wizard QRG and other useful resources. endstream endobj 787 0 obj <>/Metadata 53 0 R/Pages 784 0 R/StructTreeRoot 74 0 R/Type/Catalog>> endobj 788 0 obj <>/MediaBox[0 0 612 792]/Parent 784 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 789 0 obj <>stream 1 0 obj + 7B Providers have a number of options to obtain claim status information from Medicare Administrative Contractors (MACs): Providers can enter data via the Interactive Voice Response (IVR) telephone systems operated by the MACs. You will need Adobe Reader to open PDFs on this site. Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. 0000041995 00000 n Official websites use .govA 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. 0000025810 00000 n The Agency is aware of concerns regarding requiring all organizational (Type 2) providers to acquire and apply new NPIs to their current and future service locations. By using this site, you agree to the If you would like to receive information regarding providers that were sanctioned by the Agency prior to July 1, 2009, please contact our Public Records Office at (850) 412-3688. Example: ME99999 or ME069999. 2023 Accurate Biometrics, Inc. | All rights reserved. ( The benefit information provided is a brief summary, not a complete description of benefits. 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." 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, MedicaidProvider Directory - Region 1 (PDF), MedicaidProvider Directory - Region 2 (PDF), MedicaidProvider Directory - Region 3 (PDF), MedicaidProvider Directory - Region 4 (PDF), MedicaidProvider Directory - Region 5 (PDF), MedicaidProvider Directory - Region 6 (PDF), MedicaidProvider Directory - Region 7 (PDF), MedicaidProvider Directory - Region 8 (PDF), MedicaidProvider Directory - Region 9 (PDF), MedicaidProvider Directory - Region 10 (PDF), MedicaidProvider Directory - Region 11 (PDF), Serving Escambia, Okaloosa, Santa Rosa and Walton counties, Serving Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla and Washington counties, Serving Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union counties, Serving Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties, Serving Hardee, Highlands, Hillsborough, Manatee and Polk counties, Serving Brevard, Orange, Osceola and Seminole counties, Serving Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties, Serving Indian River, Martin, Okeechobee, Palm Beach and St. Lucie counties. 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. To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. Download the free version of Adobe Reader. hbbbd`b``* / endstream endobj 50 0 obj <>/Metadata 3 0 R/Pages 2 0 R/StructTreeRoot 5 0 R/Type/Catalog/ViewerPreferences<>>> endobj 51 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 0.0 -396.0]>>/PageUIDList<0 211>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 52 0 obj [/Separation/PANTONE#20Blue#20072#20CVC#201/DeviceCMYK<>] endobj 53 0 obj <>stream TAXONOMY IS NOT VALID FOR REFERRING PROVIDER, TAXONOMY IS INVALID - DTL REFERRING PROVIDER, TAXONOMY IS MISSING - DTL REFERRING PROVIDER, TAXONOMY IS NOT VALID FOR DTL REFERRING PROVIDER, ROPA Taxonomy Is Invalid Attending Provider, ROPA Taxonomy Is Not Valid For Attending Provider, ROPA Taxonomy Is Missing Attending Provider, ROPA Taxonomy Is Not Valid For Ordering Provider, ROPA Taxonomy Is Invalid Dtl Ordering 0000063183 00000 n You can decide how often to receive updates. Need access to the UnitedHealthcare Provider Portal? 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 Agency for Health Care Administration (Agency) would like to announce the availability of the Provider Master List (PML) and Pending Provider List (PPL) test files. Provider Type(s): ALL Revised PML Tip Sheet 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. 7:30 AM - 6 PM ET. Sunshine Health is a managed care plan with a Florida Medicaid contract. If you dont take action by your PML expiration date, you will be terminated from the Sunshine Health network on your PML expiration date. Please contact the Public Records office for questions about the public records requests. Providers can search for all Medicaid IDs associated to an NPI without having to navigate away from their secure account to use other resources to find this information. All Contacts. Out-of-State Registered providers enrolled as provider type 16 RESIDENTIAL AND FREESTANDING PSYCHIATRIC FACILITY. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. Billing provider taxonomy missing or invalid on claim, Submit corrected claim with correct billing provider taxonomy, Rendering provider taxonomy missing or invalid on claim, Submit corrected claim with correct rendering provider taxonomy. Please review the Holiday Office %PDF-1.4 % 2 Prov 2 Default Pay Multiple Service Locations, To view the complete list of CORE/CAQH Compliant EOB Clarifications, visit our website at: 835 | Florida Medicaid Web Portal (flmmis.com), For more information, or to submit questions related to the revised edits, email the Health Plan Support team at healthplan.support@gainwelltechnologies.com. 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. endobj 0000048907 00000 n V>*Iw!G2BtEfg]"g3z,6hmqI B.o`]])mohc/toB;*hAVygVwr =u%30Nb\\Byrp2" ;:RZ'd UEw%sJaP:|Jmf\SH)/)F(1NuUxz(`5Yc|H( eF]W)` 7GI\3@b1N+pZ4+LCFHdM$|a-OT,64M"7QweyFfZBy?krn,Qa2/~ZUs'Yic?bfD!|4uY@>6.ePcG2-$(+^#Kq]ZC$S4F. Sign up to get the latest information about your choice of CMS topics. To distribute the funds appropriated for the Medicaid provider minimum wage requirement, AHCA has been directed to increase Medicaid managed care reimbursement rates and certain Medicaid fee-for-service fee schedules. INVALID- PLEASE CHECK SPELLING, SPACING, ORDERING SERVICE ADDRESS IS INVALID- Megamenu requires javascript to be enabled in your browser. You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. This requirement follows the mandate the AHCA enacted on March 1, 2022, requiring all healthcare professionals providing care to Medicaid enrollees to include specific identifiers when filing claims. 0000041535 00000 n lock Default Pay Multiple Service Locations, Performing hbbd```b``A$"Y &$3&8d SIt+ Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved You must include the following information for billing and rendering providers when submitting claims: What you need to do This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. endobj 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 Toll Free: (877) 423-4746. Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. HWn]E8?p3==/),0@fX D2 r1@&F9`00Ig` \ 0000020302 00000 n 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 Florida Medicaid. 0 Default Pay Multiple Service Locations, Other endstream endobj startxref Registered providers enrolled as provider type 97 MANAGED CARE TREATING PROVIDER - NON-MEDICAID. code to match the state Provider Master List (PML). 0000048276 00000 n Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. State Profiles Every state's Medicaid and CHIP program is changing and improving - most states are expanding coverage for low-income adults; all states are modernizing their Medicaid/CHIP eligibility, enrollment and renewal processes and systems, and taking advantage of many of the new flexibilities provided by the Affordable Care Act. Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. %PDF-1.6 % 292 0 obj <>/Filter/FlateDecode/ID[<0291B0836E45394FB468471EBBC545E0>]/Index[268 37]/Info 267 0 R/Length 115/Prev 471263/Root 269 0 R/Size 305/Type/XRef/W[1 3 1]>>stream Default Pay Multiple Service Locations, Referring The process for provisional provider enrollment will be located on the New Medicaid Providers page, under the Provider Services menu. For more information on these new self-service features, please visit the Quick Reference Guides (QRG) page of the Florida Medicaid public Web Portal, by navigating to Provider Services >> Training >> Quick Reference Guides. Humana Healthy Horizons in Florida is a Medicaid product of Humana Medical Plan Inc. LC17772FL0522 (FLHKCNLEN) Healthcare Provider Resource Guide - Statewide (Regions 1 through 11) Humana Healthy Horizons in Florida provider web page Your Humana Healthy Horizons in Florida provider website has a variety of materials and resources to help your Humana endstream endobj 269 0 obj <. Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. Limitations, co-payments and restrictions may apply. 2 0 obj . 10/31/22. 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 Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims 0000001417 00000 n The benefit information provided is a brief summary, not a complete description of benefits. providers that render services to eligible Medicaid recipients. Closure document for a comprehensive list of 2023 scheduled holidays. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. Florida Medicaid Preferred Drug Program Pharmacy Prior Authorization Forms Pharmacy Services Preferred Drug List (PDL) Medicaid Provider Informational Publications Provider Bulletins Provider Fee Schedules Provider Handbooks Public Information for Providers Medicaid Reimbursement Related Information Medicaid Reimbursement Rates The new NPI to Medicaid ID Search Engine tool will display 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. 0000000016 00000 n YouTube page for Georgia Medicaid; How can we help? 0000011496 00000 n Call Us. Revised CARC/RARC Combinations for Encounter Submissions, New and Enhanced Self-Service Features Now Available, Provider Master List and Pending Provider List Test Files - Now Available, Important Upcoming Policy Change: New and Enhanced Self-Service Features Available February 2022, Updated Provider Master List Tip Sheet Now Available, New Location Code (NLC) Wizard and National Provider Identifier (NPI) Crosswalk Enhancement Notifications, Referring, Ordering, Prescribing, and Attending (ROPA) Claims, 2023 Gainwell Technologies. Providers and Agents. 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). Some providers may not perform certain services based on religious or moral beliefs. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. 0000026201 00000 n Managed Care Provisional Out-of-network Provider Enrollment form to DXC Technology, at FL-emergent-enroll@dxc.com. Throughout this initiative, the Agency and Gainwell will keep the provider and health plan communities apprised of changes as they occur via Agency e-Alert notifications. 0000017333 00000 n 0000048537 00000 n CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. 0000013101 00000 n Some providers are called essential providers. They provide care to members statewide. Please be sure to submit all five pages of the attestation. Updating NPI Crosswalk entity data (NPI, Taxonomy, and Zip+4) used for billing to fee-for-service claims or encounter submissions that include a date of service prior to March 1, 2022. See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. 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 Secure .gov websites use HTTPSA TIN - Tax ID Number . b\[py @ W9v|L39Ri@ L( Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Master List of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items Potentially Subject to Conditions of Payment, Medicare Fee-for-Service Compliance Programs, Master List of DMEPOS Items Potentially Subject to Conditions of Payment, Supplemental Medical Review Contractor (SMRC), Required Face-to-Face Encounter and Written Order Prior to Delivery List (PDF).

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