florida medicaid provider master list florida medicaid provider master list

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 Complete Enrollment for Your Medicaid ID. 0000063432 00000 n 0000042555 00000 n Please note that a new browser window will open. trailer <<9525EF5C7FA24921844CA5259BD404D3>]/Prev 78233/XRefStm 1251>> startxref 0 %%EOF 85 0 obj <>stream (Use fewer fields to produce more results: See Search Help), Privacy Statement | 49 37 Download the free version of Adobe Reader. The Enrollment Tracking Search feature has been updated to include application deficiency reasons. Password Resets. Call your provider advocate for more information. To enroll, you must have an NPI. 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. By using this site, you agree to the X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . 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. Default Pay Multiple Service Locations, Referring 0000019903 00000 n 0000001572 00000 n 0000011496 00000 n stream 0000022399 00000 n %%EOF The benefit information provided is a brief summary, not a complete description of benefits. If you would like to search for a complete list of licensed providers, please visit our data portal. AHCA - Agency for Health Care Administration. If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. Managed Care Plan with a Florida Medicaid contract. You will need Adobe Reader to open PDFs on this site. Agency for Health Care Administration; P.O. (Updated 02/15/2023). E I IW42@ Va~(i&^ L ,d(SJ{K"K7(52jT^FT,48P$1XT4k8e. 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. Provider. These enhancements will be available to Fully enrolled, Limited enrolled, and ROPA enrolled providers. 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). 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. 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. %%EOF 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. PML - Provider Master List. 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 hmo6 Please try your search again with other search values. The Complete one or more search fields. Failure to keep an active status disqualifies providers from receiving payment. 0 This impacted providers who had more than one state Medicaid ID. Default Pay Multiple Service Locations, Referring 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. Default Pay Multiple Service Locations, Performing b\[py @ W9v|L39Ri@ L( 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. 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. 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 You also have to meet Nursing Facility level of care. You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. 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. Heres how you know. 0000074223 00000 n endobj This requirement also helps ensure we have the proper information needed to promptly pay your claims. Limitations, co-payments and restrictions may apply. Closure document for a comprehensive list of 2023 scheduled holidays. 0000001036 00000 n You must include the following information for billing and rendering providers when submitting claims: What you need to do Some providers may not perform certain services based on religious or moral beliefs. This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. Share sensitive information only on official, secure websites. Changes will impact the process for registering, validating, and correcting new and existing provider information. . 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> <>/Metadata 210 0 R/ViewerPreferences 211 0 R>> The Recipient Procedure Lookup is available from the Claims menu or the Eligibility menu. *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! Find a Provider Contact Us. We can help. 304 0 obj <>stream Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. Please visit the Hurricane Preparedness page frequently to remain up-to-date with the latest information as it is made available. lock 292 0 obj <>/Filter/FlateDecode/ID[<0291B0836E45394FB468471EBBC545E0>]/Index[268 37]/Info 267 0 R/Length 115/Prev 471263/Root 269 0 R/Size 305/Type/XRef/W[1 3 1]>>stream 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. Out-of-State Registered providers enrolled as provider type 16 RESIDENTIAL AND FREESTANDING PSYCHIATRIC FACILITY. Please review the Known Issues and Informational Items List for details listed related to the MMIS. Providers who fail to sign the agreement will be subject to audits and recoupment of funds associated with the minimum wage requirement. 0000018945 00000 n 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 0000011307 00000 n On June 2, 2022, Governor Ron DeSantis signed the Freedom First budget for State Fiscal Year (SFY) 2022-2023. 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. 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. website belongs to an official government organization in the United States. 0000017512 00000 n 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). Humana Healthy Horizons in Florida is a Medicaid product of Humana Medical Plan Inc. LC17772FL0522 (FLHKCNLEN) Healthcare Provider Resource Guide - Statewide (Regions 1 through 11) Humana Healthy Horizons in Florida provider web page Your Humana Healthy Horizons in Florida provider website has a variety of materials and resources to help your Humana 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 Sign up to get the latest information about your choice of CMS topics. PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- AHCA will reopen ATNs for ALF providers who previously submitted an application that was terminated for incomplete documentation within the last six months. Additional information on the status of your Florida Medicaid enrollment application is now available through self-service on the public Web Portal. Detail Default Pay Multiple Service Locations, Ordering 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). 0000063183 00000 n 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. T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL 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. Download the free version of Adobe Reader. All Contacts. Email Advisory | 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. 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. For more information contact the Managed Care Plan. Health Plan Portal User Manual. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. 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- An updated Provider Master List tip sheet is now available on the Managed Care Support section of the Throughout this initiative, the Agency and Gainwell will keep the provider and health plan communities apprised of changes as they occur via Agency e-Alert notifications. Or start a search using ourFind A Providertool. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Managed Care Provisional Out-of-network Provider Enrollment form to DXC Technology, at FL-emergent-enroll@dxc.com. Providers can access this information on the Enrollment Status page under the Provider Services tab. 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. %PDF-1.7 Only eligible enrolled Organizational (Group) providers operating under the same Federal Employer Identification Number (FEIN/Tax ID), may enroll additional service locations. For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . lock The agency will be posting related updates to X12 837 companion guides soon. 4 0 obj For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. Action Required: Please complete the application wizard with AHCA online to renew and/or complete your Medicaid ID registration. 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. Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. Medicaid Fair Hearing; `]).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 0000019074 00000 n Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. D2 r1@&F9`00Ig` \ 0000013101 00000 n Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. For additional assistance, please contact Provider Enrollment at 1-800-289-7799, Option 4. HWn]E8?p3==/),0@fX 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. hb```f``f`a`,gf@ a+P dk3~Gx0m`c``v[@q4#RrhUn 1 (sHslFi\X The process for provisional provider enrollment will be located on the New Medicaid Providers page, under the Provider Services menu. Florida Medicaid. 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. Fort Lauderdale, Florida. 0000020302 00000 n Disclaimer | ( 0000024293 00000 n NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. post on health plan encounter submissions. 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. All rights reserved. Locate the appropriate taxonomy code that is . 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. For more information contact the Managed Care Plan. The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. 0000026201 00000 n Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. 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 2 Default Pay Multiple Service Locations, Facility Default Pay Multiple Service Locations, Other The QRG Page has links to the NPI Self-Service Tool QRG, Address Maintenance Wizard QRG and other useful resources. View the Master List (PDF). COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. 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. Send a Message. The Florida Medicaid Web Portal supports the Microsoft Edge Chromium browser which can be downloaded from the Microsoft website. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. 0000041535 00000 n | Illinois Fingerprint Vendor Agency (license # 262.000016) | r]G(c>|2]eVg\PP <> See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. 1 0 obj % Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older. October 8, 2021, a new self . [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. Sign in with your Florida Medicaid account (use new password if you recently completed a reset). We update the Code List to conform to the most recent publications of CPT and HCPCS . You can decide how often to receive updates. 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. 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/ 0000001251 00000 n To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. 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. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Providers are encouraged to stay connected by visiting the Florida Medicaid Public Web Portal often for the most up-to-date information on these changes. endobj Providers can submit claim status inquiries via the Medicare Administrative Contractors' provider Internet . 0000015958 00000 n Date: 10/31/22. 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. 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. NPI - National Provider Identifier. 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. 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). The Agency will implement the revised PML and PPL formats on February 25th, 2022. https:// ) 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. 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. 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