florida medicaid provider master list

Provider. Please review the Holiday Office endstream endobj startxref 0000026201 00000 n This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. 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 Agency will implement the revised PML and PPL formats on February 25th, 2022. 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. You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. Some providers may not perform certain services based on religious or moral beliefs. These enhancements will be available to Fully enrolled, Limited enrolled, and ROPA enrolled providers. .gov <>/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>> 0000063432 00000 n hbbd```b``A$"Y &$3&8d SIt+ 0000022399 00000 n 0000073968 00000 n The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. . YouTube page for Georgia Medicaid; How can we help? 2 Default Pay Multiple Service Locations, Facility %PDF-1.4 % PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS Address Maintenance Wizard: The current Change of Address (COA) Wizard has been renamed to the Address Maintenance Wizard. 0000011307 00000 n ? YM}O}H-~u.:t `'m@#q# t3>:khAC^Qdb.KktxU#\^Xuv=5 Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. The agency will be posting related updates to X12 837 companion guides soon. 49 37 Out-of-State Registered providers enrolled as provider type 16 RESIDENTIAL AND FREESTANDING PSYCHIATRIC FACILITY. 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. Email Advisory | %PDF-1.5 % 0000019074 00000 n Send a Message. The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. Some providers are called essential providers. They provide care to members statewide. View the Master List (PDF). 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). 7:30 AM - 6 PM ET. Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. Need access to the UnitedHealthcare Provider Portal? Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. Claims and encounters passed whenever a one-to-one match was found. 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. 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. 0000001251 00000 n 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. The Recipient Procedure Lookup is available from the Claims menu or the Eligibility menu. hbbd```b``65 d3E`rX$LX$XDNL q%VV@&F`Jg-@ T 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. Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. We can help. *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! 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. following taxonomy edits are not new but will continue to pay and Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 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- Medicaid Fair Hearing; 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. 0000042555 00000 n 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Heres how you know. The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. 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. 0000041535 00000 n INVALID- PLEASE CHECK SPELLING, SPACING, ORDERING SERVICE ADDRESS IS INVALID- 0000000016 00000 n Questions? 0000014536 00000 n 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 Health plans can access the sample test files with the new layout on the Submission Information page of the Florida Medicaid Web Portal. Please review the Known Issues and Informational Items List for details listed related to the MMIS. providers that render services to eligible Medicaid recipients. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. 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. 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 Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older. 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 will reopen ATNs for ALF providers who previously submitted an application that was terminated for incomplete documentation within the last six months. hb```e``@(2K.D8pA5agE7KU1xt40[ q(K a`di)>LL3a<2^-pcIr|n0\a:MH330;X]?H3Q1@ G/ . 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. X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . Health Plan Portal User Manual. Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. An official website of the United States government % This enhancement replaces the New Service Type or Address Request form that is currently used to request a secondary location. 268 0 obj <> endobj 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 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. The process for provisional provider enrollment will be located on the New Medicaid Providers page, under the Provider Services menu. NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. Default Pay Multiple Service Locations, Other %%EOF The Florida Medicaid Web Portal supports the Microsoft Edge Chromium browser which can be downloaded from the Microsoft website. Sign in with your Florida Medicaid account (use new password if you recently completed a reset). Beginning October 8, 2021, a new self-service feature, the New Location Code (NLC) Wizard, will be available to eligible providers in the Florida Medicaid Secure Web Portal. 0000011496 00000 n 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 Effective October 1, 2021, any fee-for-service claim submitted with a National Provider Identifier for a ROPA provider not enrolled with Florida Medicaid will be denied. . Secure .gov websites use HTTPSA Default Pay Multiple Service Locations, Referring Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. Changes will impact the process for registering, validating, and correcting new and existing provider information. 0000017333 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 An updated Provider Master List tip sheet is now available on the Managed Care Support section of the CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. %PDF-1.7 Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. (cont. lock 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. 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. Call Us. Claim submissions . Primary: (404) 657-5468. Revised CMS-1500 Claim Form (front . 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. Florida Medicaid. 826 0 obj <>stream Share sensitive information only on official, secure websites. 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 Please contact the Public Records office for questions about the public records requests. Call your provider advocate for more information. 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. stream Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. 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. Please note that a new browser window will open. Please be sure to submit all five pages of the attestation. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. 0000015958 00000 n | r]G(c>|2]eVg\PP 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. %PDF-1.6 % Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. To enroll, you must have an NPI. The list of certified browsers can be found on the. Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. Limitations, co-payments and restrictions may apply. lock All rights reserved. This impacted providers who had more than one state Medicaid ID. This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. 0000024293 00000 n website belongs to an official government organization in the United States. On June 2, 2022, Governor Ron DeSantis signed the Freedom First budget for State Fiscal Year (SFY) 2022-2023. 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 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. 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. 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). The New Service Type or Address Request form will no longer be processed. INVALID, REFERRING 2 ZIP CODE IS MISSING/ Failure to keep an active status disqualifies providers from receiving payment. The benefit information provided is a brief summary, not a complete description of benefits. 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. 0 COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. In support of validation that a health care provider meets these requirements, AHCCCS publishes two listings as follows on a regular basis: AHCCCS Active, Registered Providers by NPI who may Refer, Order, Prescribe, or Attend ROPA Excepted Providers List (Residents, Interns, Pharmacists) Steps To Comply with ROPA During the Registration Extension You can decide how often to receive updates. This requirement also helps ensure we have the proper information needed to promptly pay your claims. Password Resets. 0000074223 00000 n trailer <<9525EF5C7FA24921844CA5259BD404D3>]/Prev 78233/XRefStm 1251>> startxref 0 %%EOF 85 0 obj <>stream Monday - Friday. Escambia, Okaloosa, Santa Rosa and Walton Counties, Bay, Calhoun, Gulf, Holmes, Jackson, Washington, Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor and Wakulla Counties, Alachua, Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy, Putnam, Suwannee, Citrus, Hernando, Lake, Marion, Sumter and Union Counties, Baker, Clay, Duval, Flagler, Nassau, Saint Johns and Volusia Counties, Hardee, Highlands, Polk, Manatee and Hillsborough Counties, Brevard, Orange, Osceola and Seminole Counties, Charlotte, DeSoto, Sarasota, Glades, Hendry, Lee and Collier Counties, Indian River, Martin, Okeechobee, St. Lucie and Palm Beach Counties, Annual Regulatory PlansFlorida Department of Health (pdf).