T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL Heres how you know. 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). NPI - National Provider Identifier. 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. Registered providers enrolled as provider type 97 MANAGED CARE TREATING PROVIDER - NON-MEDICAID. 786 0 obj <> endobj providers that render services to eligible Medicaid recipients. lock 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. 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. 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 Sign up to get the latest information about your choice of CMS topics. following taxonomy edits are not new but will continue to pay and | Illinois Fingerprint Vendor Agency (license # 262.000016) r>LFoc6rw,0-ccIp3@IqusJ. 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. hmo6 0000048537 00000 n | D61, Referring, Ordering, Prescribing, and Attending Providers, Known Issues and Informational Items List, Holiday Office An updated Provider Master List tip sheet is now available on the Managed Care Support section of the 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 endobj Call Us. This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. Please be sure to submit all five pages of the attestation. This requirement also helps ensure we have the proper information needed to promptly pay your claims. 0000041995 00000 n Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. 0000041273 00000 n Send a Message. Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . document for a comprehensive list of 2023 scheduled maintenance dates. Fort Lauderdale, Florida. Failure to keep an active status disqualifies providers from receiving payment. INVALID, REFERRING SERVICE ADDRESS IS INVALID- means youve safely connected to the .gov website. post on health plan encounter submissions. Left navigation requires javascript to be enabled in your browser. Several of these new CARC/RARC combinations have been revised and will no longer cause a denial on encounter submissions. The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. 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. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. The Agency will implement the revised PML and PPL formats on February 25th, 2022. 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. Please visit the Hurricane Preparedness page frequently to remain up-to-date with the latest information as it is made available. hbbd```b``65 d3E`rX$LX$XDNL q%VV@&F`Jg-@ T Sign in with your Florida Medicaid account (use new password if you recently completed a reset). Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. hb```e``@(2K.D8pA5agE7KU1xt40[ q(K a`di)>LL3a<2^-pcIr|n0\a:MH330;X]?H3Q1@ G/ TIN - Tax ID Number . YouTube page for Georgia Medicaid; How can we help? AHCA will reopen ATNs for ALF providers who previously submitted an application that was terminated for incomplete documentation within the last six months. or Default Pay Multiple Service Locations, Attending The benefit information provided is a brief summary, not a complete description of benefits. 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. 0000018945 00000 n 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. 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. Action Required: Please complete the application wizard with AHCA online to renew and/or complete your Medicaid ID registration. 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). Default Pay Multiple Service Locations, Performing To enroll, you must have an NPI. Complete one or more search fields. PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- 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 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 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- 0000073968 00000 n 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 endstream endobj 269 0 obj <. The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. Please contact the Public Records office for questions about the public records requests. 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. Sunshine Health is a managed care plan with a Florida Medicaid contract. 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 code to match the state Provider Master List (PML). https:// 0000063432 00000 n 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. 0000011307 00000 n Some providers are called essential providers. They provide care to members statewide. You can decide how often to receive updates. PLEASE CHECK SPELLING, SPACING, ATTENDING SERVICE ADDRESS IS INVALID- Additional information can be found in the NLC Quick Reference Guide (QRG), located in the Add Additional Locations section of the Enrollment Forms page. AHCA - Agency for Health Care Administration. (cont. 0000019453 00000 n Provider Type(s): ALL Revised PML Tip Sheet 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. 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). 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 0000017333 00000 n Detail Default Pay Multiple Service Locations, Ordering 0000011496 00000 n Sunshine Health is a managed care plan with a Florida Medicaid contract. To become a Medicare provider and file Medicare claims, you must first enroll in the Medicare program. All Contacts. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. Monday - Friday. Throughout this initiative, the Agency and Gainwell will keep the provider and health plan communities apprised of changes as they occur via Agency e-Alert notifications. %PDF-1.5 % 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. FLSMPLY-CD-003934-22 July 2022 . 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. 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. 0000024293 00000 n A new application must be submitted if the ATN was terminated before March 2022. Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. <> We update the Code List to conform to the most recent publications of CPT and HCPCS . 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 [email protected]. 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. To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. Health Plan Portal User Manual. 268 0 obj <> endobj To be reimbursed for services rendered to eligible Florida Medicaid recipients, providers not already enrolled in Florida Medicaid (out-of-state or in-state) must complete a provisional (temporary) enrollment application. 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), [email protected], Call 1-800-289-7799, Option 4 for any additional provider enrollment questions. 0000001417 00000 n Providers can submit claim status inquiries via the Medicare Administrative Contractors' provider Internet . 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). %PDF-1.7 Disclaimer | Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. 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