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. COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. 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. This is done through the provision of quality services to meet the care needs of . 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 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). 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. https:// 0000026034 00000 n
Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 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. 7s]]7~}qn{wVZFl)[Vj}v~{=~{[j
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On the Florida Medicaid Web Portal you can access the Provider Master List. or 49 37
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Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. For instructions, see ourFind A Provider Step-by-Step Guide (PDF). %PDF-1.6
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The Recipient Procedure Lookup is available from the Claims menu or the Eligibility menu. 0000019453 00000 n
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Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. A new application must be submitted if the ATN was terminated before March 2022. 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? You also have to meet Nursing Facility level of care. 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 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. Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. 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. 2 Default Pay Multiple Service Locations, Facility
lock Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . 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 826 0 obj
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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. Changes will impact the process for registering, validating, and correcting new and existing provider information. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. This requirement also helps ensure we have the proper information needed to promptly pay your claims. 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. No records found. Primary: (404) 657-5468. 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 Sunshine Health is a managed care plan with a Florida Medicaid contract. . following taxonomy edits are not new but will continue to pay and
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. 0
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. Health Plan Portal User Manual. %PDF-1.5
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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. Providers can access this information on the Enrollment Status page under the Provider Services tab. We can help. 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/
Find a Provider For Members For Providers Get Insured Coronavirus Information For Providers Value-Based Incentive Programs Billing and Claims Utilization Management Coronavirus Information Become a Provider Contact Us Eligibility Verification Login Pharmacy Pre-Auth Check Provider News Provider Resources Provider Complaints Assessment Tools To enroll, you must have an NPI. document for a comprehensive list of 2023 scheduled maintenance dates. lock stream
Transactions submitted with a From Date of Service of March 1, 2022, or later must use a valid taxonomy associated with the providers specialty. 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. Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. View the Master List (PDF). hbbbd`b``* /
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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 Default Pay Multiple Service Locations, Attending
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. INVALID- PLEASE CHECK SPELLING, SPACING, ORDERING SERVICE ADDRESS IS INVALID-
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. Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. Managed Care Provisional Out-of-network Provider Enrollment form to DXC Technology, at FL-emergent-enroll@dxc.com. The list of certified browsers can be found on the. This impacted providers who had more than one state Medicaid ID. 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. Date: 10/31/22. See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. 2 0 obj
. Or start a search using ourFind A Providertool. Providers who fail to sign the agreement will be subject to audits and recoupment of funds associated with the minimum wage requirement. 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. 0000063432 00000 n
Managed Care Plan with a Florida Medicaid contract. The PML and PPL revised layouts will accommodate the new NPI Mapping Logic, which will be implemented on March 1st, 2022. All rights reserved. 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. Thank you for choosing the Children's Medical Services (CMS) Managed Care Plan for your health care needs. Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. 7:30 AM - 6 PM ET. | r]G(c>|2]eVg\PP Questions? Example: ME99999 or ME069999. ( An official website of the United States government 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. 0000015958 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."
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Additional information on the status of your Florida Medicaid enrollment application is now available through self-service on the public Web Portal. Password Resets. 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. To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. Florida Department of Health | Division of Medical Quality Assurance Search Services, To verify a Nurse Licensure Compact Multi-State RN or LPN License, access. endobj
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. Email Us. Closure document for a comprehensive list of 2023 scheduled holidays. 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. You will need Adobe Reader to open PDFs on this site. 0000041970 00000 n
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 Please note that a new browser window will open. `]).vpF'~E/\YY6GK%p &JjcsJ>z$W
Kd2~@:_oVwL%JK1 v?x7#2B_>:f/7*jg*I3qnuDQgktd.S=~L\"#K7[G^3P0F>gf)8?&{y>h**|@lhb%85Px>jEff;HhCA?1gRhah8;?xuAk?yg?!yN?f~@oF We recommend you use a certified browser to ensure that the application functions as expected. Master List of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items Potentially Subject to Conditions of Payment CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. hbbd```b``65 d3E`rX$LX$XDNL q%VV@&F`Jg-@ T
If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. 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. YouTube page for Georgia Medicaid; How can we help? PML - Provider Master List. website belongs to an official government organization in the United States. HWn]E8?p3==/),0@fX Address Maintenance Wizard: The current Change of Address (COA) Wizard has been renamed to the Address Maintenance Wizard. For more information contact the Managed Care Plan. The benefit information provided is a brief summary, not a complete description of benefits. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS
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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. 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. The agency will be posting related updates to X12 837 companion guides soon. All Contacts. The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you.
Privacy Policy. .gov State Profiles Every state's Medicaid and CHIP program is changing and improving - most states are expanding coverage for low-income adults; all states are modernizing their Medicaid/CHIP eligibility, enrollment and renewal processes and systems, and taking advantage of many of the new flexibilities provided by the Affordable Care Act. NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. 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 Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. endobj
Have questions? 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- Complete one or more search fields. Additional information can be found in the NLC Quick Reference Guide (QRG), located in the Add Additional Locations section of the Enrollment Forms page. 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. You must include the following information for billing and rendering providers when submitting claims: What you need to do Toll Free: (877) 423-4746. 786 0 obj
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Several of these new CARC/RARC combinations have been revised and will no longer cause a denial on encounter submissions. 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.