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 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. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. 0000017333 00000 n | D61, Referring, Ordering, Prescribing, and Attending Providers, Known Issues and Informational Items List, Holiday Office 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). 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. Providers can submit claim status inquiries via the Medicare Administrative Contractors' provider Internet . AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. 0000026201 00000 n E I IW42@ Va~(i&^ L ,d(SJ{K"K7(52jT^FT,48P$1XT4k8e. 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. <>/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>> | Illinois Fingerprint Vendor Agency (license # 262.000016) 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. The Enrollment Tracking Search feature has been updated to include application deficiency reasons. 1 0 obj *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! 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. Default Pay Multiple Service Locations, Referring 0000025923 00000 n Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. Sunshine Health is a managed care plan with a Florida Medicaid contract. This enhancement replaces the New Service Type or Address Request form that is currently used to request a secondary location. This enhanced wizard allows Individual providers (Entity Type 1) to add additional service location addresses to their existing files. 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 purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . or 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. Use the following chart to know whats needed to correct your claim based on the remittance denial code and go to our Claims Interactive Guide for instructions on how to submit a claim correction. 0000026034 00000 n 0000020302 00000 n 0000063432 00000 n All Contacts. Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status Health Plan Portal User Manual. 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. 0000026103 00000 n 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). Privacy Policy. Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. Closure document for a comprehensive list of 2023 scheduled holidays. The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. 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 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. Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. Changes will impact the process for registering, validating, and correcting new and existing provider information. The Florida Medicaid Web Portal supports the Microsoft Edge Chromium browser which can be downloaded from the Microsoft website. 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 49 0 obj <> endobj xref The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. Sign up to get the latest information about your choice of CMS topics. 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 Online Form. Action Required: Please complete the application wizard with AHCA online to renew and/or complete your Medicaid ID registration. This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. The benefit information provided is a brief summary, not a complete description of benefits. Find a Provider Contact Us. 0000001251 00000 n Fill out the Statewide Medicaid Managed Care Registered Provider Initiative form (PDF) and submit it to: medicaideligibilityoutreach@ahca.myflorida.com. 0000063183 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. Use the, Verify your information matches what you submit on your claims. If you dont take action by your PML expiration date, you will be terminated from the Sunshine Health network on your PML expiration date. 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 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). Call Us. 49 37 This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL 0000000016 00000 n 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. PML - Provider Master List. CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. `]).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 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. Monday - Friday. Providers can access this information on the Enrollment Status page under the Provider Services tab. NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. The table below presents the most recent, point-in-time count of total Medicaid and CHIP enrollment in for the last day of the indicated month, and is not solely a count of those newly enrolled during the reporting period. Megamenu requires javascript to be enabled in your browser. This requirement also helps ensure we have the proper information needed to promptly pay your claims. lock website belongs to an official government organization in the United States. endstream endobj startxref 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 also have to meet Nursing Facility level of care. https:// 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. Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. Transactions submitted with a From Date of Service of March 1, 2022, or later must use a valid taxonomy associated with the providers specialty. Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. 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 Date: 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/ AHCA requirements endobj Left navigation requires javascript to be enabled in your browser. D2 r1@&F9`00Ig` \ People on Medicaid will get services using one or more of these plan types: Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved You must include the following information for billing and rendering providers when submitting claims: What you need to do Please be sure to submit all five pages of the attestation. 0000001572 00000 n Default Pay Multiple Service Locations, Referring Complete Enrollment for Your Medicaid ID. 0000041970 00000 n <> 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 Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. <> In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. 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. 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. 0000017512 00000 n An updated Provider Master List tip sheet is now available on the Managed Care Support section of the PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS %PDF-1.4 % On the Florida Medicaid Web Portal you can access the Provider Master List. 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. 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 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. Call your provider advocate for more information. FLSMPLY-CD-003934-22 July 2022 . See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. HWn]E8?p3==/),0@fX The Recipient Procedure Lookup is available from the Claims menu or the Eligibility menu. Password Resets. %%EOF 0000001036 00000 n b\[py @ W9v|L39Ri@ L( Address Maintenance Wizard: The current Change of Address (COA) Wizard has been renamed to the Address Maintenance Wizard. (Updated 02/15/2023). View the Master List (PDF). hbbd```b``A$"Y &$3&8d SIt+ trailer <<9525EF5C7FA24921844CA5259BD404D3>]/Prev 78233/XRefStm 1251>> startxref 0 %%EOF 85 0 obj <>stream TAXONOMY IS NOT VALID FOR REFERRING PROVIDER, TAXONOMY IS INVALID - DTL REFERRING PROVIDER, TAXONOMY IS MISSING - DTL REFERRING PROVIDER, TAXONOMY IS NOT VALID FOR DTL REFERRING PROVIDER, ROPA Taxonomy Is Invalid Attending Provider, ROPA Taxonomy Is Not Valid For Attending Provider, ROPA Taxonomy Is Missing Attending Provider, ROPA Taxonomy Is Not Valid For Ordering Provider, ROPA Taxonomy Is Invalid Dtl Ordering 0000019074 00000 n If you are a provider meeting the criteria above and currently have an Application Tracking Number (ATN), AHCAs Provider Enrollment team will assist you in completing the process. [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. 0000041535 00000 n Agency for Health Care Administration; P.O. 0000014536 00000 n 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. 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 ) Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 0000001417 00000 n %PDF-1.5 % 0000019453 00000 n 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
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