Healthcare Provider Resource Guide Statewide (Regions 1 - Humana Additional information can be found in the NLC Quick Reference Guide (QRG), located in the Add Additional Locations section of the Enrollment Forms page. 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. 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. Password Resets. Sign up to get the latest information about your choice of CMS topics. (Updated 02/15/2023). 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. And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. hb```f``f`a`,gf@ a+P dk3~Gx0m`c``v[@q4#RrhUn 1
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Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. We update the Code List to conform to the most recent publications of CPT and HCPCS . Additional information on the status of your Florida Medicaid enrollment application is now available through self-service on the public Web Portal. Complete Enrollment for Your Medicaid ID. 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
This enhanced wizard allows Individual providers (Entity Type 1) to add additional service location addresses to their existing files. Complete Enrollment for Your Medicaid ID | Sunshine Health Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. Address Maintenance Wizard: The current Change of Address (COA) Wizard has been renamed to the Address Maintenance Wizard. + 7B %PDF-1.7
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. 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. 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. website belongs to an official government organization in the United States. Health Plan Portal User Manual. | r]G(c>|2]eVg\PP Heres how you know. X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . 805 0 obj
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PDF Exceptions Process - LIBERTY Dental Plan 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. On the Florida Medicaid Web Portal you can access the Provider Master List. No records found. Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. 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). Florida Medicaid - FLRules NPI - National Provider Identifier. <>
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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
Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. 10/31/22. 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). Use the, Verify your information matches what you submit on your claims. For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . 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. ( Limitations, co-payments and restrictions may apply. lock Provider Links - Florida Default Pay Multiple Service Locations, Referring
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. Provider Directories | Florida Medicaid | Sunshine Health Sunshine Health is a managed care plan with a Florida Medicaid contract. 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. 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. Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. 0000042555 00000 n
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." 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. 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. 0000000016 00000 n
Please note that a new browser window will open. Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. Provider Services - Florida The PML and PPL revised layouts will accommodate the new NPI Mapping Logic, which will be implemented on March 1st, 2022. Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. PDF FL Medicaid Reference Guide Megamenu requires javascript to be enabled in your browser. PDF Provider Directory Data Quality - Texas . FL DOH MQA Search Portal | License Verification 0000026201 00000 n
CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. 0000018945 00000 n
The New Service Type or Address Request form will no longer be processed. 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. 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. Medicaid Provider Enrollment Requirements Fact Sheet Online Form. 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. 0000041535 00000 n
Provider Directories | Florida Medicaid | Sunshine Health %PDF-1.5
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Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. The benefit information provided is a brief summary, not a complete description of benefits. PDF NPI crosswalk logic change updates - Simply Healthcare Plans To become a Medicare provider and file Medicare claims, you must first enroll in the Medicare program. Locate the appropriate taxonomy code that is . Default Pay Multiple Service Locations, Referring
If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. document for a comprehensive list of 2023 scheduled maintenance dates. 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 A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. 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. Download the free version of Adobe Reader. Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . State Profiles | Medicaid means youve safely connected to the .gov website. 7s]]7~}qn{wVZFl)[Vj}v~{=~{[j
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The benefit information provided is a brief summary, not a complete description of benefits. Search Providers | Florida Department of Health Master List of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items Potentially Subject to Conditions of Payment CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. TIN - Tax ID Number . Official websites use .govA Action Required: Please complete the application wizard with AHCA online to renew and/or complete your Medicaid ID registration. Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. The Agency will implement the revised PML and PPL formats on February 25th, 2022. You will need Adobe Reader to open PDFs on this site. 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. 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. 0000001572 00000 n
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All rights reserved. YouTube page for Georgia Medicaid; How can we help? 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. Florida ORI Numbers and Professions - Accurate Biometrics 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. 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. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 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. You also have to meet Nursing Facility level of care. For additional assistance, please contact Provider Enrollment at 1-800-289-7799, Option 4. Please try your search again with other search values. Or start a search using ourFind A Providertool. 850-298-7123. List of CPT/HCPCS Codes | CMS - Centers for Medicare & Medicaid Services 0000011307 00000 n
Providers | Georgia Medicaid Have questions? 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 Date: 10/31/22. 0000011496 00000 n
Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. Thank you for choosing the Children's Medical Services (CMS) Managed Care Plan for your health care needs. Sunshine Health is a managed care plan with a Florida Medicaid contract. The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Failure to keep an active status disqualifies providers from receiving payment. Health plans can access the sample test files with the new layout on the Submission Information page of the Florida Medicaid Web Portal. 0000048907 00000 n
The Recipient Procedure Lookup is available from the Claims menu or the Eligibility menu. Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. We can help. NPI Directory State of Florida - NPI Profile Disclaimer |
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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. 0000073968 00000 n
Access the PML on AHA's Managed are site at - WellCare Florida State Medicaid Managed Care - Health - Health Plans and Program Closure, 835 | Florida Medicaid Web Portal (flmmis.com), healthplan.support@gainwelltechnologies.com, 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).