florida medicaid provider master list

Address Maintenance Wizard: The current Change of Address (COA) Wizard has been renamed to the Address Maintenance Wizard. Share sensitive information only on official, secure websites. This is done through the provision of quality services to meet the care needs of . Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. 3 0 obj 0000041273 00000 n %PDF-1.4 % The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. 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. + 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. Failure to keep an active status disqualifies providers from receiving payment. Some providers are called essential providers. They provide care to members statewide. 521 '(6$17,6 *29(5125 0$5< & 0$<+(: 6(&5(7$5< +rph _ $erxw 8v _ 0hglfdlg _ /lfhqvxuh 5hjxodwlrq _ 5hsruw )udxg _ 5hsruw 0hglfdlg ,vvxh &rpsodlqw In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. (Use fewer fields to produce more results: See Search Help), Privacy Statement | Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. document for a comprehensive list of 2023 scheduled maintenance dates. hb``Pd``e```a@@q%4IT$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 The Florida Medicaid Taxonomy Guide, found under Enrollment Forms on the Florida Medicaid Web Portal, open_in_new identifies taxonomies that correlate to provider types and specialties FLMMIS Provider Enrollment open_in_new lists provider types Claims, Billing and Payments on UnitedHealthcare Provider Portal to review and resubmit claims Questions? or 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 The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. PLEASE CHECK SPELLING, SPACING, ATTENDING SERVICE ADDRESS IS INVALID- You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. means youve safely connected to the .gov website. Default Pay Multiple Service Locations, Other On June 2, 2022, Governor Ron DeSantis signed the Freedom First budget for State Fiscal Year (SFY) 2022-2023. 49 37 Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS lock Several of these new CARC/RARC combinations have been revised and will no longer cause a denial on encounter submissions. 0000015958 00000 n To enroll, you must have an NPI. This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. 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. 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. Megamenu requires javascript to be enabled in your browser. 0000011496 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. (cont. 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. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Fill out the Statewide Medicaid Managed Care Registered Provider Initiative form (PDF) and submit it to: medicaideligibilityoutreach@ahca.myflorida.com. 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 0000001036 00000 n Official websites use .govA 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. 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. endstream endobj 269 0 obj <. We update the Code List to conform to the most recent publications of CPT and HCPCS . Health Plan Portal User Manual. This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . 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. 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. 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. X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . On the Florida Medicaid Web Portal you can access the Provider Master List. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. You must include the following information for billing and rendering providers when submitting claims: What you need to do See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. (Updated 02/15/2023). The Freedom First Budget provided over $600 million in funding to the Agency for Health Care Administration (Agency or AHCA) for the sole purpose of increasing the minimum wage for employees of Medicaid providers to at least $15.00 an hour. Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. endstream endobj startxref 304 0 obj <>stream 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 786 0 obj <> endobj PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- following taxonomy edits are not new but will continue to pay and Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. 0 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. They are located on the AHCA public web portal under Provider Services/EDI/Companion guides. Changes will impact the process for registering, validating, and correcting new and existing provider information. 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. Under the Managed Care menu, you will want to select Provider Master List, which can be found under the Registration column (third from the right). To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. 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. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. %PDF-1.6 % 0000025923 00000 n 0000074223 00000 n For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . 0000041995 00000 n 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. TIN - Tax ID Number . CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. 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. 0000024293 00000 n To become a Medicare provider and file Medicare claims, you must first enroll in the Medicare program. NPI - National Provider Identifier. ? YM}O}H-~u.:t `'m@#q# t3>:khAC^Qdb.KktxU#\^Xuv=5 Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 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. Complete Enrollment for Your Medicaid ID. The process for provisional provider enrollment will be located on the New Medicaid Providers page, under the Provider Services menu. 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. AHCA requirements E I IW42@ Va~(i&^ L ,d(SJ{K"K7(52jT^FT,48P$1XT4k8e. %PDF-1.7 0000063950 00000 n x]moF a?J. "W%6TTofkG For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. Email Us. Providers and Agents. 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. Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. This impacted providers who had more than one state Medicaid ID. Example: ME99999 or ME069999. Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. <> Default Pay Multiple Service Locations, Referring 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. All rights reserved. YouTube page for Georgia Medicaid; How can we help? Sunshine Health is a managed care plan with a Florida Medicaid contract. Sign in with your Florida Medicaid account (use new password if you recently completed a reset). 7:30 AM - 6 PM ET. INVALID, REFERRING SERVICE ADDRESS IS INVALID- Change of Address (COA) Wizard: The current COA Wizard will be enhanced to allow 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 Florida Medicaid Web Portal that details the changes. 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. Find a Provider Contact Us. Please visit the Hurricane Preparedness page frequently to remain up-to-date with the latest information as it is made available. 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 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. 0000019453 00000 n 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. 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. View the Master List (PDF). _b>? 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 AHCA will reopen ATNs for ALF providers who previously submitted an application that was terminated for incomplete documentation within the last six months. 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 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. Providers who fail to sign the agreement will be subject to audits and recoupment of funds associated with the minimum wage requirement. 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 instructions, see ourFind A Provider Step-by-Step Guide (PDF). Limitations, co-payments and restrictions may apply. 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 These enhancements will be available to Fully enrolled, Limited enrolled, and ROPA enrolled providers. 0000000016 00000 n INVALID, REFERRING 2 ZIP CODE IS MISSING/ 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. The Enrollment Tracking Search feature has been updated to include application deficiency reasons. If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. Florida Medicaid. 0000014536 00000 n 0000026034 00000 n endobj HWn]E8?p3==/),0@fX COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL 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. hbbd```b``A$"Y &$3&8d SIt+ Email Advisory | Transactions submitted with a From Date of Service of March 1, 2022, or later must use a valid taxonomy associated with the providers specialty. 4 0 obj An updated Provider Master List tip sheet is now available on the Managed Care Support section of the The PML and PPL revised layouts will accommodate the new NPI Mapping Logic, which will be implemented on March 1st, 2022. Password Resets. The benefit information provided is a brief summary, not a complete description of benefits. 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 2023 Accurate Biometrics, Inc. | All rights reserved. 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

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