Sunshine Health is a managed care plan with a Florida Medicaid contract. If you dont take action by your PML expiration date, you will be terminated from the Sunshine Health network on your PML expiration date. This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. trailer <<9525EF5C7FA24921844CA5259BD404D3>]/Prev 78233/XRefStm 1251>> startxref 0 %%EOF 85 0 obj <>stream 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. Please review the Scheduled Maintenance D2 r1@&F9`00Ig` \ As part of the Registered Provider Enrollment Initiative, the Agency for Health Care Administration (AHCA) is offering enrollment assistance to Skilled Nursing Facilities, Assisted Living Facilities (ALFs) and Residential and Freestanding Psychiatric Facilities that are actively seeking compliance with the Registered Provider Initiative. 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). This enhanced wizard allows Individual providers (Entity Type 1) to add additional service location addresses to their existing files. endobj 268 0 obj <> endobj %PDF-1.5 % Florida State Offices Responsible for State Exclusions and Program 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. 0000017512 00000 n Date: Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. People on Medicaid will get services using one or more of these plan types: Several of these new CARC/RARC combinations have been revised and will no longer cause a denial on encounter submissions. ACCESSING PROVIDER MASTER LIST - PDF Free Download 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 Share sensitive information only on official, secure websites. Medicaid Provider Enrollment Requirements Fact Sheet Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . 2023 Accurate Biometrics, Inc. | All rights reserved. For Providers - Virginia YouTube page for Georgia Medicaid; How can we help? 0000019453 00000 n Sunshine Health is a managed care plan with a Florida Medicaid contract. Florida | Medicaid Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. 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 program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. The Agency will implement the revised PML and PPL formats on February 25th, 2022. Florida State Medicaid Managed Care - Tab Window Title The agency will be posting related updates to X12 837 companion guides soon. . 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 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. 0000001036 00000 n Out-of-State Registered providers enrolled as provider type 16 RESIDENTIAL AND FREESTANDING PSYCHIATRIC FACILITY. 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 Sign in with your Florida Medicaid account (use new password if you recently completed a reset). ) 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. 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. x]moF a?J. "W%6TTofkG AHCA Find Medicaid Doctors, Dentists, and Specialists - Florida 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. List of CPT/HCPCS Codes | CMS - Centers for Medicare & Medicaid Services JavaScript required - Sign In Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. endstream endobj startxref Locate the appropriate taxonomy code that is . Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. INVALID- PLEASE CHECK SPELLING, SPACING, ORDERING SERVICE ADDRESS IS INVALID- Some providers may not perform certain services based on religious or moral beliefs. Any provider that has a payment suspension based on a credible allegation of fraud within the last 10 years,[23] Any provider excluded within the past 10 years by HHS-OIG or an SMA,[24, 25] Any provider that has a qualifying Medicaid overpayment,[ 26] The provider is enrolling within 6 months of the date of the lifting of a INVALID, REFERRING 2 ZIP CODE IS MISSING/ NPI Directory State of Florida - NPI Profile We update the Code List to conform to the most recent publications of CPT and HCPCS . Provider, ROPA Taxonomy Is Missing Dtl Ordering 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. Default Pay Multiple Service Locations, Performing 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. The PLEASE CHECK SPELLING, SPACING, ATTENDING SERVICE ADDRESS IS INVALID- The Agency is also required to enter into a supplemental wage agreement with each impacted Medicaid Provider by October 1, 2022, to ensure compliance with the minimum wage requirements. Early Intervention Services | Sunshine Health | r]G(c>|2]eVg\PP Secure .gov websites use HTTPSA 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). Need access to the UnitedHealthcare Provider Portal? b\[py @ W9v|L39Ri@ L( Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. PML - Provider Master List. PDF Claim Issues Tip Sheet: Billing of Provider Data Elements-Taxonomy/PML Provider Enrollment - Florida 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 Medicaid Fair Hearing; Some providers are called essential providers. They provide care to members statewide. Fill out the Statewide Medicaid Managed Care Registered Provider Initiative form (PDF) and submit it to: medicaideligibilityoutreach@ahca.myflorida.com. 0000048537 00000 n 826 0 obj <>stream An official website of the United States government Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. lock Online Form. 0000024293 00000 n You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. The PML and PPL revised layouts will accommodate the new NPI Mapping Logic, which will be implemented on March 1st, 2022. 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. 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. means youve safely connected to the .gov website. Call Us. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 0000018945 00000 n 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. 0000025810 00000 n following taxonomy edits are not new but will continue to pay and For more information contact the Managed Care Plan. Changes will impact the process for registering, validating, and correcting new and existing provider information. 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. On the Florida Medicaid Web Portal you can access the Provider Master List. Agency for Health Care Administration; P.O. 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 providers that render services to eligible Medicaid recipients. Florida State Medicaid Managed Care - Home Page INVALID, REFERRING SERVICE ADDRESS IS INVALID- 0000042555 00000 n You can decide how often to receive updates. 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 See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. This is done through the provision of quality services to meet the care needs of . Complete one or more search fields. 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. 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. Health plans can access the sample test files with the new layout on the Submission Information page of the Florida Medicaid Web Portal. *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! 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. Florida Medicaid Providers & Health Insurance Plans | Sunshine Health Limitations, co-payments and restrictions may apply. Florida State Medicaid Managed Care - Health - Health Plans and Program 0000001251 00000 n Primary: (404) 657-5468. Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. 0000014536 00000 n AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. Access the PML on AHA's Managed are site at - WellCare <> Default Pay Multiple Service Locations, Referring Heres how you know. Complete Enrollment for Your Medicaid ID. 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- 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. 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. | D61, Referring, Ordering, Prescribing, and Attending Providers, Known Issues and Informational Items List, Holiday Office Megamenu requires javascript to be enabled in your browser. NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. Preauthorization and Notification Lists for Healthcare Providers - Humana In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. Thank you for choosing the Children's Medical Services (CMS) Managed Care Plan for your health care needs. Claim Status Request and Response | CMS T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL Providers who fail to sign the agreement will be subject to audits and recoupment of funds associated with the minimum wage requirement. We recommend you use a certified browser to ensure that the application functions as expected. 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. Provider Directories | Florida Medicaid | Sunshine Health Failure to keep an active status disqualifies providers from receiving payment. 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . 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. Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims 0000074223 00000 n 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. 850-298-7123. 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. Additional information can be found in the NLC Quick Reference Guide (QRG), located in the Add Additional Locations section of the Enrollment Forms page. <>/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>> The process for provisional provider enrollment will be located on the New Medicaid Providers page, under the Provider Services menu. 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. PDF Florida Medicaid Health Care Alert - mytnfl.com endstream endobj 787 0 obj <>/Metadata 53 0 R/Pages 784 0 R/StructTreeRoot 74 0 R/Type/Catalog>> endobj 788 0 obj <>/MediaBox[0 0 612 792]/Parent 784 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 789 0 obj <>stream Default Pay Multiple Service Locations, Other Providers and Agents. You also have to meet Nursing Facility level of care. 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. 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 New Service Type or Address Request form will no longer be processed. You will need Adobe Reader to open PDFs on this site. The Managed Care pages provide managed care plans with helpful information and tools related to fiscal agent file exchange, guidance for understanding data, and reports. Left navigation requires javascript to be enabled in your browser. These enhancements will be available to Fully enrolled, Limited enrolled, and ROPA enrolled providers. .gov 0 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? 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. endstream endobj startxref 0000019903 00000 n 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. 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. [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. 0000015958 00000 n 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. Agency for Health Care Administration - Florida This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. Call your provider advocate for more information. %%EOF Managed Care Provisional Out-of-network Provider Enrollment form to DXC Technology, at FL-emergent-enroll@dxc.com. HWn]E8?p3==/),0@fX To enroll, you must have an NPI. %%EOF The Agency for Health Care Administration (Agency) would like to announce the availability of the Provider Master List (PML) and Pending Provider List (PPL) test files. r>LFoc6rw,0-ccIp3@IqusJ. . Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status <>/Metadata 210 0 R/ViewerPreferences 211 0 R>> . 304 0 obj <>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. Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older. Florida ORI Numbers and Professions - Accurate Biometrics Detail Default Pay Multiple Service Locations, Ordering Email Advisory | Please be sure to submit all five pages of the attestation. %PDF-1.4 % 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 lock AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. 49 37 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 %PDF-1.6 % And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the 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). Questions? Please visit the Hurricane Preparedness page frequently to remain up-to-date with the latest information as it is made available. 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. (Use fewer fields to produce more results: See Search Help), Privacy Statement | (Updated 02/15/2023). 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. Official websites use .govA Default Pay Multiple Service Locations, Referring hb```e``@(2K.D8pA5agE7KU1xt40[ q(K a`di)>LL3a<2^-pcIr|n0\a:MH330;X]?H3Q1@ G/ Privacy Policy. 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