florida medicaid provider master list

Florida Department of Health | Division of Medical Quality Assurance Search Services, To verify a Nurse Licensure Compact Multi-State RN or LPN License, access. 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 Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims The Florida Medicaid Web Portal supports the Microsoft Edge Chromium browser which can be downloaded from the Microsoft website. 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 0000026201 00000 n 2023 Accurate Biometrics, Inc. | All rights reserved. lock post on health plan encounter submissions. Sign in with your Florida Medicaid account (use new password if you recently completed a reset). Example: ME99999 or ME069999. On the Florida Medicaid Web Portal you can access the Provider Master List. 2 0 obj ) 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. %%EOF 0000026103 00000 n Providers who fail to sign the agreement will be subject to audits and recoupment of funds associated with the minimum wage requirement. 0000020302 00000 n 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). The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. 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. The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. You must include the following information for billing and rendering providers when submitting claims: What you need to do 0000041995 00000 n Password Resets. 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. For more information contact the Managed Care Plan. 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. The benefit information provided is a brief summary, not a complete description of benefits. 0000001417 00000 n Please review the Holiday Office AHCA requirements This impacted providers who had more than one state Medicaid ID. Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. 0000019453 00000 n D2 r1@&F9`00Ig` \ 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 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 Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. Action Required: Please complete the application wizard with AHCA online to renew and/or complete your Medicaid ID registration. Agency for Health Care Administration; P.O. Official websites use .govA Closure document for a comprehensive list of 2023 scheduled holidays. 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- 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. INVALID, REFERRING SERVICE ADDRESS IS INVALID- [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. Change of Address (COA) Wizard: The current COA Wizard will be enhanced to allow Individual providers (Entity Type 1) to add additional service location addresses to their existing files. Some providers are called essential providers. They provide care to members statewide. The Enrollment Tracking Search feature has been updated to include application deficiency reasons. In support of validation that a health care provider meets these requirements, AHCCCS publishes two listings as follows on a regular basis: AHCCCS Active, Registered Providers by NPI who may Refer, Order, Prescribe, or Attend ROPA Excepted Providers List (Residents, Interns, Pharmacists) Steps To Comply with ROPA During the Registration Extension Default Pay Multiple Service Locations, Referring Thank you for choosing the Children's Medical Services (CMS) Managed Care Plan for your health care needs. Under the Managed Care menu, you will want to select Provider Master List, which can be found under the Registration column (third from the right). The Agency is aware of concerns regarding requiring all organizational (Type 2) providers to acquire and apply new NPIs to their current and future service locations. Find a Provider Contact Us. Additional information can be found in the NLC Quick Reference Guide (QRG), located in the Add Additional Locations section of the Enrollment Forms page. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the Florida Medicaid Web Portal that details the changes. hbbd```b``65 d3E`rX$LX$XDNL q%VV@&F`Jg-@ T For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. or You will need Adobe Reader to open PDFs on this site. This requirement also helps ensure we have the proper information needed to promptly pay your claims. <>/Metadata 210 0 R/ViewerPreferences 211 0 R>> Several of these new CARC/RARC combinations have been revised and will no longer cause a denial on encounter submissions. 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. Only eligible enrolled Organizational (Group) providers operating under the same Federal Employer Identification Number (FEIN/Tax ID), may enroll additional service locations. Email Advisory | Please note that a new browser window will open. 4 0 obj 7:30 AM - 6 PM ET. Effective Nov. 1, 2022, if you submit claims with identifier information that doesnt match your provider enrollment data entered with the Agency for Health Care Administration (AHCA), your claims will be denied. .gov 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. 1 0 obj Sunshine Health is a managed care plan with a Florida Medicaid contract. *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! . endstream endobj startxref Sunshine Health is a managed care plan with a Florida Medicaid contract. 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. hb```f``f`a`,gf@ a+P dk3~Gx0m`c``v[@q4#RrhUn 1 (sHslFi\X 2 Default Pay Multiple Service Locations, Facility 0000000016 00000 n 0000011496 00000 n . trailer <<9525EF5C7FA24921844CA5259BD404D3>]/Prev 78233/XRefStm 1251>> startxref 0 %%EOF 85 0 obj <>stream 786 0 obj <> endobj Providers and Agents. CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. 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. 0000041273 00000 n %%EOF . 0000018945 00000 n 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/ An updated Provider Master List tip sheet is now available on the Managed Care Support section of the Monday - Friday. 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 No records found. Complete Enrollment for Your Medicaid ID. 0000011307 00000 n providers that render services to eligible Medicaid recipients. Share sensitive information only on official, secure websites. For instructions, see ourFind A Provider Step-by-Step Guide (PDF). 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. <>/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 Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. endobj from pg. Sign up to get the latest information about your choice of CMS topics. Please review the Known Issues and Informational Items List for details listed related to the MMIS. 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 Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. 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. Toll Free: (877) 423-4746. Date: 10/31/22. 304 0 obj <>stream <> All Contacts. document for a comprehensive list of 2023 scheduled maintenance dates. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS endstream endobj 269 0 obj <. The list of certified browsers can be found on the.

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