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document for a comprehensive list of 2023 scheduled maintenance dates. Locate the appropriate taxonomy code that is . 0000048537 00000 n 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. %%EOF Providers and Agents. Secure .gov websites use HTTPSA By using this site, you agree to the This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. The agency will be posting related updates to X12 837 companion guides soon. Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. 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. 826 0 obj <>stream 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. endstream endobj startxref AHCA requirements 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 Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. 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. Claims and encounters passed whenever a one-to-one match was found. Please contact the Public Records office for questions about the public records requests. 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. FLSMPLY-CD-003934-22 July 2022 . 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. 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. or Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. 0000017333 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? People on Medicaid will get services using one or more of these plan types: Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. Claim submissions . The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. Thank you for choosing the Children's Medical Services (CMS) Managed Care Plan for your health care needs. Beginning March 1, 2022, an enhancement will be applied to the NPI Mapping Logic which will affect providers and health plans who submit claims and/or encounters to Florida Medicaid. 0000001036 00000 n Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 7s]]7~}qn{wVZFl)[Vj}v~{=~{[j v{a-V'::n?Igcml7,[ -vOx7Kfo%ZNoFv>Z[OX&xuYXXOqk |}`aHvo9~4q={K(92jo!5#42A\v_p \|GNMGn\, Cj`oHu_duxRR0g8Qmz$F# Y= XX;w_ZpcK+(' q&JXGD\Cw6 \hzp#y:Nj:JDZ> 0000019453 00000 n Managed Care Plan with a Florida Medicaid contract. 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. 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 Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. 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 The process for provisional provider enrollment will be located on the New Medicaid Providers page, under the Provider Services menu. The list of certified browsers can be found on the. ? YM}O}H-~u.:t `'m@#q# t3>:khAC^Qdb.KktxU#\^Xuv=5 If you dont take action by your PML expiration date, you will be terminated from the Sunshine Health network on your PML expiration date. Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. To enroll, you must have an NPI. 0000013101 00000 n code to match the state Provider Master List (PML). Primary: (404) 657-5468. For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . All rights reserved. https:// Changes will impact the process for registering, validating, and correcting new and existing provider information. providers that render services to eligible Medicaid recipients. hb```e``@(2K.D8pA5agE7KU1xt40[ q(K a`di)>LL3a<2^-pcIr|n0\a:MH330;X]?H3Q1@ G/ Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. Disclaimer | Sign in with your Florida Medicaid account (use new password if you recently completed a reset). endobj Sunshine Health is a managed care plan with a Florida Medicaid contract. 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. 0000001417 00000 n An official website of the United States government 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. %PDF-1.4 % The Florida Medicaid Web Portal supports the Microsoft Edge Chromium browser which can be downloaded from the Microsoft website. 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. Medicaid Provider Directory - Region 3 (PDF) Serving Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union counties Medicaid Provider Directory - Region 4 (PDF) Serving Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties 304 0 obj <>stream Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. They are located on the AHCA public web portal under Provider Services/EDI/Companion guides. AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. 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. This is done through the provision of quality services to meet the care needs of . Download the free version of Adobe Reader. Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. 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. 0000042555 00000 n The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. <>/Metadata 210 0 R/ViewerPreferences 211 0 R>> Only eligible enrolled Organizational (Group) providers operating under the same Federal Employer Identification Number (FEIN/Tax ID), may enroll additional service locations. 0000063183 00000 n 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. Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . INVALID, REFERRING SERVICE ADDRESS IS INVALID- 0000018945 00000 n Florida Medicaid. Out-of-State Registered providers enrolled as provider type 16 RESIDENTIAL AND FREESTANDING PSYCHIATRIC FACILITY. 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. Find a Provider Contact Us. website belongs to an official government organization in the United States. You must include the following information for billing and rendering providers when submitting claims: What you need to do 0000025923 00000 n _b>? Please visit the Hurricane Preparedness page frequently to remain up-to-date with the latest information as it is made available. 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 QRG Page has links to the NPI Self-Service Tool QRG, Address Maintenance Wizard QRG and other useful resources. x]moF a?J. "W%6TTofkG 2 0 obj On the Florida Medicaid Web Portal you can access the Provider Master List. Sunshine Health is a managed care plan with a Florida Medicaid contract. Limitations, co-payments and restrictions may apply. 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. TIN - Tax ID Number . 786 0 obj <> endobj 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." 0000011307 00000 n 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. For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. 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 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. 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 0000041535 00000 n 0000001572 00000 n The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. 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. 7:30 AM - 6 PM ET. Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. Address Maintenance Wizard: The current Change of Address (COA) Wizard has been renamed to the Address Maintenance Wizard. 0 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. D2 r1@&F9`00Ig` \ October 8, 2021, a new self . 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. The Recipient Procedure Lookup is available from the Claims menu or the Eligibility menu. 3 0 obj See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. Please review the Holiday Office Date: 10/31/22. If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. You will need Adobe Reader to open PDFs on this site. 0000063950 00000 n Providers can access this information on the Enrollment Status page under the Provider Services tab. Download the free version of Adobe Reader. 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. 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 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. ( Default Pay Multiple Service Locations, Attending 10/31/22. 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