Please review the Holiday Office People on Medicaid will get services using one or more of these plan types: Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. 0000048276 00000 n 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. For more information contact the Managed Care Plan. Share sensitive information only on official, secure websites. 0000063183 00000 n To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. Online Form. lock Locate the appropriate taxonomy code that is . 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-1.6 % Sign up to get the latest information about your choice of CMS topics. This enhancement replaces the New Service Type or Address Request form that is currently used to request a secondary location. 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. Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older. Limitations, co-payments and restrictions may apply. You will need Adobe Reader to open PDFs on this site. 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- Password Resets. 0000073968 00000 n 0000074223 00000 n 304 0 obj <>stream `]).vpF'~E/\YY6GK%p &JjcsJ>z$W Kd2~@:_oVwL%JK1 v?x7#2B_>:f/7*jg*I3qnuDQgktd.S=~L\"#K7[G^3P0F>gf)8?&{y>h**|@lhb%85Px>jEff;HhCA?1gRhah8;?xuAk?yg?!yN?f~@oF To enroll, you must have an NPI. 0 Claims and encounters passed whenever a one-to-one match was found. CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. hb``Pd``e```a@@q%4IT$rfm@L!L!b)Cc[$00G2+_ w30Vif]%,Q o? endstream endobj 84 0 obj <>/Filter/FlateDecode/Index[5 44]/Length 20/Size 49/Type/XRef/W[1 1 1]>>stream To become a Medicare provider and file Medicare claims, you must first enroll in the Medicare program. On the Florida Medicaid Web Portal you can access the Provider Master List. Health Plan Portal User Manual. Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. Please review the Scheduled Maintenance NPI Registration Form: The NPI Registration Form will be discontinued with the following exceptions: NPI to Medicaid ID Search Engine: The existing tool will be enhanced and will be accessible via the secure Web Portal. Claim submissions . Complete Enrollment for Your Medicaid ID. Complete one or more search fields. Provider. Some providers are called essential providers. They provide care to members statewide. 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. Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. This enhanced wizard allows Individual providers (Entity Type 1) to add additional service location addresses to their existing files. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the 0000020302 00000 n 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. Monday - Friday. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. _b>? 0000001572 00000 n The Default Pay Multiple Service Locations, Performing 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). T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL Send a Message. Sunshine Health is a managed care plan with a Florida Medicaid contract. 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. Email Advisory | Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. x]moF a?J. "W%6TTofkG 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. View the Master List (PDF). 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. %PDF-1.4 % 0000019453 00000 n . Closure document for a comprehensive list of 2023 scheduled holidays. We recommend you use a certified browser to ensure that the application functions as expected. By using this site, you agree to the 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 Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Providers who fail to sign the agreement will be subject to audits and recoupment of funds associated with the minimum wage requirement. Download Provider File The information contained in this directory is made available to the public by the Illinois Department of Healthcare and Family Services (IDHFS) to assist Medical providers in verifying an actively enrolled ordering/referring/prescribing Medicaid provider. To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. ( 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. The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. 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). 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. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 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 No records found. For instructions, see ourFind A Provider Step-by-Step Guide (PDF). DXC will add the provider to the Florida Medicaid Management Information System (FLMMIS) and the Provider Master List, so that after the provider is paid encounters will successfully process in the FLMMIS. endobj 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. means youve safely connected to the .gov website. Use the, Verify your information matches what you submit on your claims. 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. 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 These enhancements will be available to Fully enrolled, Limited enrolled, and ROPA enrolled providers. An official website of the United States government 4 0 obj 0000001417 00000 n This requirement also helps ensure we have the proper information needed to promptly pay your claims. 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). 0000025923 00000 n Sign in with your Florida Medicaid account (use new password if you recently completed a reset). 0000018945 00000 n You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. INVALID- PLEASE CHECK SPELLING, SPACING, ORDERING SERVICE ADDRESS IS INVALID- 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. AHCA - Agency for Health Care Administration. % 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." COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. 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. 7s]]7~}qn{wVZFl)[Vj}v~{=~{[j v{a-V'::n?Igcml7,[ -vOx7Kfo%ZNoFv>Z[OX&xuYXXOqk |}`aHvo9~4q={K(92jo!5#42A\v_p \|GNMGn\, Cj`oHu_duxRR0g8Qmz$F# Y= XX;w_ZpcK+(' q&JXGD\Cw6 \hzp#y:Nj:JDZ> Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . Default Pay Multiple Service Locations, Other Claims with a From Date of Service of March 1, 2022, or after should use the ZIP+4 associated with the provider service location address. 2023 Accurate Biometrics, Inc. | All rights reserved. This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. Master List of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items Potentially Subject to Conditions of Payment CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. Megamenu requires javascript to be enabled in your browser. Effective Nov. 1, 2022, if you submit claims with identifier information that doesnt match your provider enrollment data entered with the Agency for Health Care Administration (AHCA), your claims will be denied. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the Florida Medicaid Web Portal that details the changes. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. Managed Care Plan with a Florida Medicaid contract. 826 0 obj <>stream [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. Default Pay Multiple Service Locations, Referring They are located on the AHCA public web portal under Provider Services/EDI/Companion guides. 0000048907 00000 n A new application must be submitted if the ATN was terminated before March 2022. website belongs to an official government organization in the United States. hbbd```b``65 d3E`rX$LX$XDNL q%VV@&F`Jg-@ T Sunshine Health is a managed care plan with a Florida Medicaid contract. The alphabetical listing of providers by specialty allows you to easily locate all the providers in the area that have the same scope of practice. 2 Default Pay Multiple Service Locations, Facility Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 29 0 R 30 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Email Us. Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. Fort Lauderdale, Florida. *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! This is done through the provision of quality services to meet the care needs of . %%EOF trailer <<9525EF5C7FA24921844CA5259BD404D3>]/Prev 78233/XRefStm 1251>> startxref 0 %%EOF 85 0 obj <>stream The New Service Type or Address Request form will no longer be processed. HWn]E8?p3==/),0@fX endobj 0000042555 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. The interactive Provider Search Tool allows you to search for a quality health care provider in your area that is participating in the CMS Plan, including primary care physicians, hospitals, pharmacies and other health care professionals. D2 r1@&F9`00Ig` \ 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. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. 0000041535 00000 n 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). 1 0 obj Medicaid Fair Hearing; For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. For additional information and the latest updates from the Agency for Health Care Administration (Agency), please visit the COVID-19 page on the Agency's website. b\[py @ W9v|L39Ri@ L( You can decide how often to receive updates. %PDF-1.7 Please review the Known Issues and Informational Items List for details listed related to the MMIS. https:// It must be used in conjunction with the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, which contains information about specific procedures for submitting claims for payment, and the Florida Medicaid Provider General Handbook, which describes the Florida Medicaid program. hbbd```b``A$"Y &$3&8d SIt+ January 1, 2023, Humana Healthy Horizons in Florida (Medicaid) Preauthorization and Notification List January 1, 2023, Humana Healthy Horizons in Louisiana (Medicaid) Preauthorization and Notification List January 1, 2023, Humana Healthy Horizons in South Carolina (Medicaid) Preauthorization and Notification List Detail Default Pay Multiple Service Locations, Ordering endstream endobj startxref 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. Left navigation requires javascript to be enabled in your browser. Medicaid & CHIP Enrollment Data. Changes will impact the process for registering, validating, and correcting new and existing provider information. If you would like to search for a complete list of licensed providers, please visit our data portal. In accordance with 42 Code of Federal Regulations 455.410(b), all ordering or referring physicians, or other professionals providing services to Medicaid recipients must be enrolled with Florida Medicaid. 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. 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/ from pg. 786 0 obj <> endobj PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS 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. 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. Please contact the Public Records office for questions about the public records requests. 0000014536 00000 n Default Pay Multiple Service Locations, Referring providers that render services to eligible Medicaid recipients. Download the free version of Adobe Reader. Questions? Heres how you know. 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. We can help. <> FLSMPLY-CD-003934-22 July 2022 . | D61, Referring, Ordering, Prescribing, and Attending Providers, Known Issues and Informational Items List, Holiday Office code to match the state Provider Master List (PML). 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. This impacted providers who had more than one state Medicaid ID. The following new CARC/RARC combinations will pay and post on qualifying X12 837 encounters via 835 transactions when multiple provider IDs are matched to the submitted data: Billing Providers are encouraged to stay connected by visiting the Florida Medicaid Public Web Portal often for the most up-to-date information on these changes. 0000025810 00000 n endstream endobj startxref If you dont take action by your PML expiration date, you will be terminated from the Sunshine Health network on your PML expiration date. AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. 0000015958 00000 n 521 '(6$17,6 *29(5125 0$5< & 0$<+(: 6(&5(7$5< +rph _ $erxw 8v _ 0hglfdlg _ /lfhqvxuh 5hjxodwlrq _ 5hsruw )udxg _ 5hsruw 0hglfdlg ,vvxh &rpsodlqw X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . endobj We update the Code List to conform to the most recent publications of CPT and HCPCS . 0000048537 00000 n 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 a. the Master Provider file (MPF), a Texas Medicaid and Healthcare Partnership (TMHP) data warehouse-derived pool of provider records, b. the TMHP member-facing directory or "online provider lookup" (OPL) on the TMHP website, c. the provider reconcile files, a MAXIMUS data warehouse-derived pool of provider records, and d. Limitations, co-payments and restrictions may apply. All rights reserved. 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. 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 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. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 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. Additional information on the status of your Florida Medicaid enrollment application is now available through self-service on the public Web 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. October 8, 2021, a new self . Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. 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. 7:30 AM - 6 PM ET. This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. PLEASE CHECK SPELLING, SPACING, ATTENDING SERVICE ADDRESS IS INVALID-
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