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. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. 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. 0000041535 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 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. 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. <>/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>> This enhanced wizard allows Individual providers (Entity Type 1) to add additional service location addresses to their existing files. Failure to keep an active status disqualifies providers from receiving payment. 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. Some providers may not perform certain services based on religious or moral beliefs. 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/ If you dont take action by your PML expiration date, you will be terminated from the Sunshine Health network on your PML expiration date. The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. 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 means youve safely connected to the .gov website. Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. 0000073968 00000 n All rights reserved. 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. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 0000024293 00000 n (Updated 02/15/2023). %PDF-1.4 % Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. Disclaimer | Online Form. INVALID, REFERRING 2 ZIP CODE IS MISSING/ PLEASE CHECK SPELLING, SPACING, ATTENDING SERVICE ADDRESS IS INVALID- 850-298-7123. 0000011307 00000 n Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older. 0000026103 00000 n The benefit information provided is a brief summary, not a complete description of benefits. This requirement also helps ensure we have the proper information needed to promptly pay your claims. HWn]E8?p3==/),0@fX This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. The following essential providers are part of Sunshine Healths network and are available to all members: You will need Adobe Reader to open PDFs on this site. Limitations, co-payments and restrictions may apply. 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. The new NPI to Medicaid ID Search Engine tool displays 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. Closure document for a comprehensive list of 2023 scheduled holidays. Detail Default Pay Multiple Service Locations, Ordering Please review the Scheduled Maintenance You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. or 0000001572 00000 n 2023 Accurate Biometrics, Inc. | All rights reserved. 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. AHCA will reopen ATNs for ALF providers who previously submitted an application that was terminated for incomplete documentation within the last six months. hbbd```b``A$"Y &$3&8d SIt+ Please review the Holiday Office (Use fewer fields to produce more results: See Search Help), Privacy Statement | 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. 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. A new application must be submitted if the ATN was terminated before March 2022. Florida Medicaid. 0000001417 00000 n 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? The New Service Type or Address Request form will no longer be processed. Claim submissions . (cont. Email Us. 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). On June 2, 2022, Governor Ron DeSantis signed the Freedom First budget for State Fiscal Year (SFY) 2022-2023. For more information contact the Managed Care Plan. Sign in with your Florida Medicaid account (use new password if you recently completed a reset). Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. Date: ( lock The TIN - Tax ID Number . Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. You must include the following information for billing and rendering providers when submitting claims: What you need to do Secure .gov websites use HTTPSA Please try your search again with other search values. Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. The list of certified browsers can be found on the. Provider, ROPA Taxonomy Is Missing Dtl Ordering For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. 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> 0000063432 00000 n r>LFoc6rw,0-ccIp3@IqusJ. Health Plan Portal User Manual. hb```f``f`a`,gf@ a+P dk3~Gx0m`c``v[@q4#RrhUn 1 (sHslFi\X Call your provider advocate for more information. Default Pay Multiple Service Locations, Other 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 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. Sunshine Health is a managed care plan with a Florida Medicaid contract. And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. Additional information on the status of your Florida Medicaid enrollment application is now available through self-service on the public Web Portal. 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. Managed Care Plan with a Florida Medicaid contract. 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 Revised CMS-1500 Claim Form (front . 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. 2 Default Pay Multiple Service Locations, Facility document for a comprehensive list of 2023 scheduled maintenance dates. b\[py @ W9v|L39Ri@ L( trailer <<9525EF5C7FA24921844CA5259BD404D3>]/Prev 78233/XRefStm 1251>> startxref 0 %%EOF 85 0 obj <>stream All Contacts. 0000026034 00000 n Providers who fail to sign the agreement will be subject to audits and recoupment of funds associated with the minimum wage requirement. 0000063183 00000 n 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. PLEASE CHECK SPELLING, SPACING. 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. endstream endobj startxref CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. 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. 0000019903 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 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. Call Us. Providers can submit claim status inquiries via the Medicare Administrative Contractors' provider Internet . %PDF-1.6 % 7:30 AM - 6 PM ET. 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. 0000001251 00000 n Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 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. Changes will impact the process for registering, validating, and correcting new and existing provider information. 49 37 0000063950 00000 n Default Pay Multiple Service Locations, Attending 0000019074 00000 n 805 0 obj <>/Filter/FlateDecode/ID[<08E51282E405684D9C17F1CE6F8C1661><5571271B0099974DBF27615CD82AD9C9>]/Index[786 41]/Info 785 0 R/Length 100/Prev 808182/Root 787 0 R/Size 827/Type/XRef/W[1 3 1]>>stream Please visit the Hurricane Preparedness page frequently to remain up-to-date with the latest information as it is made available. 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-1.5 % 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. We can help. 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. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. 1 0 obj 0 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. Thank you for choosing the Children's Medical Services (CMS) Managed Care Plan for your health care needs. providers that render services to eligible Medicaid recipients. 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. Download the free version of Adobe Reader. You also have to meet Nursing Facility level of care. YouTube page for Georgia Medicaid; How can we help? 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 0000042555 00000 n Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. x]moF a?J. "W%6TTofkG Sunshine Health is a managed care plan with a Florida Medicaid contract. 0000015958 00000 n This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. 0000022399 00000 n post on health plan encounter submissions. 0000026201 00000 n INVALID- PLEASE CHECK SPELLING, SPACING, ORDERING SERVICE ADDRESS IS INVALID- %%EOF 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. 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. 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 stream Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. 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. 0000000016 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. 0000001036 00000 n To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. Locate the appropriate taxonomy code that is . 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. Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! Find a Provider Contact Us. 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. People on Medicaid will get services using one or more of these plan types: Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. Complete Enrollment for Your Medicaid ID. Monday - Friday. 2 0 obj Privacy Policy. The agency will be posting related updates to X12 837 companion guides soon. 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."
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