florida medicaid provider master list

View the Master List (PDF). <> Health plans can access the sample test files with the new layout on the Submission Information page of the Florida Medicaid Web Portal. Email Us. hbbd```b``A$"Y &$3&8d SIt+ We can help. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 0000022399 00000 n <>/Metadata 210 0 R/ViewerPreferences 211 0 R>> Additional information on the status of your Florida Medicaid enrollment application is now available through self-service on the public Web Portal. 49 37 The New Service Type or Address Request form will no longer be processed. 0000017512 00000 n You will need Adobe Reader to open PDFs on this site. Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. %PDF-1.4 % For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. %PDF-1.6 % 0000024293 00000 n PLEASE CHECK SPELLING, SPACING. 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. endstream endobj startxref endobj On the Florida Medicaid Web Portal you can access the Provider Master List. Medicaid Fair Hearing; 0000011307 00000 n hb```e``@(2K.D8pA5agE7KU1xt40[ q(K a`di)>LL3a<2^-pcIr|n0\a:MH330;X]?H3Q1@ G/ hmo6 The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. Address Maintenance Wizard: The current Change of Address (COA) Wizard has been renamed to the Address Maintenance Wizard. 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. 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 Some providers are called essential providers. They provide care to members statewide. 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. 0000048537 00000 n Managed Care Provisional Out-of-network Provider Enrollment form to DXC Technology, at FL-emergent-enroll@dxc.com. 3 0 obj means youve safely connected to the .gov website. The 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. hb```f``f`a`,gf@ a+P dk3~Gx0m`c``v[@q4#RrhUn 1 (sHslFi\X Privacy Policy. 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. And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. Sign in with your Florida Medicaid account (use new password if you recently completed a reset). 0000063432 00000 n 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. + 7B The benefit information provided is a brief summary, not a complete description of benefits. 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 Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- Responsible for assisting plans and providers with the provider enrollment process, both initial and renewal; submitting provider maintenance to the Medicaid fiscal agent; receiving, tracking, and monitoring escalated issues, legislative requests, and public records requests; performing onsite reviews; coordinating and delivering plan and 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. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . Agency for Health Care Administration; P.O. People on Medicaid will get services using one or more of these plan types: 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 Revised CMS-1500 Claim Form (front . 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. Or start a search using ourFind A Providertool. HWn]E8?p3==/),0@fX 0000041535 00000 n 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. Please be sure to submit all five pages of the attestation. 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. Provider, ROPA Taxonomy Is Missing Dtl Ordering INVALID, REFERRING SERVICE ADDRESS IS INVALID- Out-of-State Registered providers enrolled as provider type 16 RESIDENTIAL AND FREESTANDING PSYCHIATRIC FACILITY. %%EOF 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 will implement the revised PML and PPL formats on February 25th, 2022. October 8, 2021, a new self . Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. | r]G(c>|2]eVg\PP Limitations, co-payments and restrictions may apply. 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. 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. You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. 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. 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. b\[py @ W9v|L39Ri@ L( Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. Default Pay Multiple Service Locations, Performing %PDF-1.7 Find a Provider Contact Us. Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. Please review the Scheduled Maintenance Updating NPI Crosswalk entity data (NPI, Taxonomy, and Zip+4) used for billing to fee-for-service claims or encounter submissions that include a date of service prior to March 1, 2022. endobj NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. Call Us. Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. 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. 0 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 268 0 obj <> endobj INVALID, REFERRING 2 ZIP CODE IS MISSING/ 850-298-7123. 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. 0000026201 00000 n For more information on the supplemental wage agreement and fee schedule increases related to the minimum wage requirements, please visit the Agencys Medicaid Provider Minimum Wage Requirements page on the Agencys website or visit the Supplemental Wage Agreement page under Agency initiatives on the public Web Portal. following taxonomy edits are not new but will continue to pay and 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. 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. For instructions, see ourFind A Provider Step-by-Step Guide (PDF). document for a comprehensive list of 2023 scheduled maintenance dates. The agency will be posting related updates to X12 837 companion guides soon. Date: 10/31/22. 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. Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . Action Required: Please complete the application wizard with AHCA online to renew and/or complete your Medicaid ID registration. Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. . Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status . By using this site, you agree to the 0000014536 00000 n To enroll, you must have an NPI. Providers and suppliers dont need to take action unless an item on the Master List also appears on one or both Required Lists: The Required Lists Comparison Chart (PDF) is a side-by-side crosswalk of both Required Lists. hbbd```b``65 d3E`rX$LX$XDNL q%VV@&F`Jg-@ T To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. The list of certified browsers can be found on the. Please try your search again with other search values. 0000048276 00000 n PML - Provider Master List. Default Pay Multiple Service Locations, Referring Please visit the Hurricane Preparedness page frequently to remain up-to-date with the latest information as it is made available. This enhancement replaces the New Service Type or Address Request form that is currently used to request a secondary location. Changes will impact the process for registering, validating, and correcting new and existing provider information. If you would like to search for a complete list of licensed providers, please visit our data portal. Fill out the Statewide Medicaid Managed Care Registered Provider Initiative form (PDF) and submit it to: medicaideligibilityoutreach@ahca.myflorida.com. 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. Send a Message. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 2 Default Pay Multiple Service Locations, Facility The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. 0000042555 00000 n 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. lock 805 0 obj <>/Filter/FlateDecode/ID[<08E51282E405684D9C17F1CE6F8C1661><5571271B0099974DBF27615CD82AD9C9>]/Index[786 41]/Info 785 0 R/Length 100/Prev 808182/Root 787 0 R/Size 827/Type/XRef/W[1 3 1]>>stream Left navigation requires javascript to be enabled in your browser. Locate the appropriate taxonomy code that is . PLEASE CHECK SPELLING, SPACING, ATTENDING SERVICE ADDRESS IS INVALID- Share sensitive information only on official, secure websites. 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. 826 0 obj <>stream Detail Default Pay Multiple Service Locations, Ordering AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view.