Sunshine Health is a managed care plan with a Florida Medicaid contract. View the Master List (PDF). This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. 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). For additional assistance, please contact Provider Enrollment at 1-800-289-7799, Option 4. CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. 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. For more information contact the Managed Care Plan. The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. code to match the state Provider Master List (PML). 0000014536 00000 n endobj Locate the appropriate taxonomy code that is . Closure document for a comprehensive list of 2023 scheduled holidays. Revised CMS-1500 Claim Form (front . Transactions submitted with a From Date of Service of March 1, 2022, or later must use a valid taxonomy associated with the providers specialty. 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 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. 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 To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. 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 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. For more information contact the Managed Care Plan. Claims and encounters passed whenever a one-to-one match was found. To enroll, you must have an NPI. Call Us. PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- Fort Lauderdale, Florida. Questions? 0000022399 00000 n %PDF-1.6 % 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. This impacted providers who had more than one state Medicaid ID. 0 The PML and PPL revised layouts will accommodate the new NPI Mapping Logic, which will be implemented on March 1st, 2022. <>/Metadata 210 0 R/ViewerPreferences 211 0 R>> 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 2 0 obj 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> They are located on the AHCA public web portal under Provider Services/EDI/Companion guides. Download the free version of Adobe Reader. Please review the Scheduled Maintenance Secure .gov websites use HTTPSA x]moF a?J. "W%6TTofkG Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. A new application must be submitted if the ATN was terminated before March 2022. Complete one or more search fields. Default Pay Multiple Service Locations, Other 0 Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved Primary: (404) 657-5468. 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. Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. means youve safely connected to the .gov website. Please try your search again with other search values. Sign up to get the latest information about your choice of CMS topics. The Enrollment Tracking Search feature has been updated to include application deficiency reasons. The benefit information provided is a brief summary, not a complete description of benefits. 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 Default Pay Multiple Service Locations, Performing Fill out the Statewide Medicaid Managed Care Registered Provider Initiative form (PDF) and submit it to: medicaideligibilityoutreach@ahca.myflorida.com. You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 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 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. Additional information on the status of your Florida Medicaid enrollment application is now available through self-service on the public Web Portal. If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. 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. These enhancements will be available to Fully enrolled, Limited enrolled, and ROPA enrolled providers. All Contacts. And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. 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. Detail Default Pay Multiple Service Locations, Ordering 0000013101 00000 n Managed Care Provisional Out-of-network Provider Enrollment form to DXC Technology, at FL-emergent-enroll@dxc.com. 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. Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. Heres how you know. 850-298-7123. %%EOF _b>? FLSMPLY-CD-003934-22 July 2022 . 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). Health plans can access the sample test files with the new layout on the Submission Information page of the Florida Medicaid Web Portal. Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. 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. Medicaid Fair Hearing; E I IW42@ Va~(i&^ L ,d(SJ{K"K7(52jT^FT,48P$1XT4k8e. Providers and Agents. 0000074223 00000 n Share sensitive information only on official, secure websites. 0000024293 00000 n Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims 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 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. 0000041535 00000 n .gov Complete Enrollment for Your Medicaid ID. For instructions, see ourFind A Provider Step-by-Step Guide (PDF). 0000019074 00000 n Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. The list of certified browsers can be found on the. The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. 0000026103 00000 n If you would like to search for a complete list of licensed providers, please visit our data portal. AHCA will reopen ATNs for ALF providers who previously submitted an application that was terminated for incomplete documentation within the last six months. 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. 1 0 obj 786 0 obj <> endobj Action Required: Please complete the application wizard with AHCA online to renew and/or complete your Medicaid ID registration.