Florida Department of Health | Division of Medical Quality Assurance Search Services, To verify a Nurse Licensure Compact Multi-State RN or LPN License, access. Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. Health plans can access the sample test files with the new layout on the Submission Information page of the Florida Medicaid Web Portal. 0000048276 00000 n 0000041995 00000 n 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. Example: ME99999 or ME069999. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the Largest Cities in Florida Miami 52,853 Tampa 26,198 Orlando 24,833 Jacksonville 24,345 Gainesville 13,594 Hialeah 10,407 Fort Myers 8,132 West Palm Beach 7,683 Sarasota 7,607 Boca Raton 7,591 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. Registered providers enrolled as provider type 97 MANAGED CARE TREATING PROVIDER - NON-MEDICAID. You also have to meet Nursing Facility level of care. Default Pay Multiple Service Locations, Referring 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. Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. 268 0 obj <> endobj (Use fewer fields to produce more results: See Search Help), Privacy Statement | In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. Left navigation requires javascript to be enabled in your browser. The list of certified browsers can be found on the. 0000014536 00000 n If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. 0000001251 00000 n This is done through the provision of quality services to meet the care needs of . 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 HWn]E8?p3==/),0@fX Default Pay Multiple Service Locations, Referring 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). 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. On June 2, 2022, Governor Ron DeSantis signed the Freedom First budget for State Fiscal Year (SFY) 2022-2023. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. Heres how you know. The agency will be posting related updates to X12 837 companion guides soon. Managed Care Plan with a Florida Medicaid contract. ) Date: 10/31/22. The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. 0000019453 00000 n 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 .gov Health Plan Portal User Manual. Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. hb```f``f`a`,gf@ a+P dk3~Gx0m`c``v[@q4#RrhUn 1 (sHslFi\X Please note that a new browser window will open. Please review the Known Issues and Informational Items List for details listed related to the MMIS. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. The new NPI self-service feature allows providers to update or add a new NPI to the Medicaid provider ID associated to the account the provider is logged into. 786 0 obj <> endobj A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. Agency for Health Care Administration; P.O. 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. 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. 0000013101 00000 n Additional information can be found in the NLC Quick Reference Guide (QRG), located in the Add Additional Locations section of the Enrollment Forms page. Limitations, co-payments and restrictions may apply. 0000041273 00000 n 826 0 obj <>stream following taxonomy edits are not new but will continue to pay and Megamenu requires javascript to be enabled in your browser. 0000048907 00000 n 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. 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 Managed Long Term Care for Medicaid enrollees 18 years and older. Detail Default Pay Multiple Service Locations, Ordering 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. 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 Managed Care pages provide managed care plans with helpful information and tools related to fiscal agent file exchange, guidance for understanding data, and reports. INVALID- PLEASE CHECK SPELLING, SPACING, ORDERING SERVICE ADDRESS IS INVALID- AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. 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 [email protected]. Have questions? CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. 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. document for a comprehensive list of 2023 scheduled maintenance dates. 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. 0000001572 00000 n 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. Complete one or more search fields. NPI - National Provider Identifier. 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 D2 r1@&F9`00Ig` \ For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . We can help. Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. 0000019903 00000 n providers that render services to eligible Medicaid recipients. 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. 0000042555 00000 n Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. code to match the state Provider Master List (PML). PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- The following self-service features are now available: NPI Self-Service Feature: A new NPI self-service tool is available to all providers via the secure Web Portal. 0 Closure, 835 | Florida Medicaid Web Portal (flmmis.com), [email protected], 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). | r]G(c>|2]eVg\PP 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 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. hmo6 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. 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 Default Pay Multiple Service Locations, Referring %PDF-1.4 % Need access to the UnitedHealthcare Provider Portal? 0000026034 00000 n Provider, ROPA Taxonomy Is Missing Dtl Ordering 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. 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). Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 0000073968 00000 n Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. FLSMPLY-CD-003934-22 July 2022 . Sign up to get the latest information about your choice of CMS topics. (Updated 02/15/2023). 0000001417 00000 n 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 Changes will impact the process for registering, validating, and correcting new and existing provider information. 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. Privacy Policy. Use the, Verify your information matches what you submit on your claims. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. 0000026201 00000 n Claim submissions . The New Service Type or Address Request form will no longer be processed. And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. INVALID, REFERRING SERVICE ADDRESS IS INVALID- Completed and signed attestations can be submitted by the physician to the Department of Health via secure email at [email protected] or via fax to 850-488-3813. 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. 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. from pg. Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. or (cont. Questions? 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." Fort Lauderdale, Florida. This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. 1 0 obj post on health plan encounter submissions. website belongs to an official government organization in the United States. For more information contact the Managed Care Plan. %PDF-1.5 % Please review the Scheduled Maintenance 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. 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. Or start a search using ourFind A Providertool. Some providers may not perform certain services based on religious or moral beliefs. On the Florida Medicaid Web Portal you can access the Provider Master List. Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved 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 0000015958 00000 n Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: [email protected]. <>/Metadata 210 0 R/ViewerPreferences 211 0 R>> You can decide how often to receive updates. 0000001036 00000 n 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. Password Resets. %PDF-1.6 % 0000024293 00000 n `]).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 COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. 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