Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. ) Need access to the UnitedHealthcare Provider Portal? Florida Medicaid - FLRules An official website of the United States government 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. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the 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. Please be sure to submit all five pages of the attestation. ACCESSING PROVIDER MASTER LIST - PDF Free Download You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- document for a comprehensive list of 2023 scheduled maintenance dates. 0000001036 00000 n This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. We update the Code List to conform to the most recent publications of CPT and HCPCS . *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! 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, MedicaidProvider Directory - Region 1 (PDF), MedicaidProvider Directory - Region 2 (PDF), MedicaidProvider Directory - Region 3 (PDF), MedicaidProvider Directory - Region 4 (PDF), MedicaidProvider Directory - Region 5 (PDF), MedicaidProvider Directory - Region 6 (PDF), MedicaidProvider Directory - Region 7 (PDF), MedicaidProvider Directory - Region 8 (PDF), MedicaidProvider Directory - Region 9 (PDF), MedicaidProvider Directory - Region 10 (PDF), MedicaidProvider Directory - Region 11 (PDF), Serving Escambia, Okaloosa, Santa Rosa and Walton counties, Serving Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla and Washington counties, Serving Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union counties, Serving Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties, Serving Hardee, Highlands, Hillsborough, Manatee and Polk counties, Serving Brevard, Orange, Osceola and Seminole counties, Serving Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties, Serving Indian River, Martin, Okeechobee, Palm Beach and St. Lucie counties. Please review the Known Issues and Informational Items List for details listed related to the MMIS. For more information contact the Managed Care Plan. Community Care Plan is owned by South Florida's most experienced names in health care: Broward Health (North Broward Hospital District) and Memorial Healthcare System (South Broward Hospital District). To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. 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. Email Advisory | 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 Complete one or more search fields. Registration | Florida Medicaid Web Portal Fill out the Statewide Medicaid Managed Care Registered Provider Initiative form (PDF) and submit it to: medicaideligibilityoutreach@ahca.myflorida.com. 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. ( The Agency for Health Care Administration (Agency) and its fiscal agent, Gainwell Technologies, would like to notify providers of upcoming enhancements to the Florida Medicaid secure Web Portal. ROPA - azahcccs.gov 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims Medicaid Provider Directory - Region 3 (PDF) Serving Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union counties Medicaid Provider Directory - Region 4 (PDF) Serving Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties Medicaid Provider Enrollment Requirements Fact Sheet Sunshine Health is a managed care plan with a Florida Medicaid contract. lock 0000000016 00000 n 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. Please contact the Public Records office for questions about the public records requests. State Profiles | Medicaid 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. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. Failure to keep an active status disqualifies providers from receiving payment. 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. b\[py @ W9v|L39Ri@ L( 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. Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. 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- Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status %PDF-1.7 Or start a search using ourFind A Providertool. On June 2, 2022, Governor Ron DeSantis signed the Freedom First budget for State Fiscal Year (SFY) 2022-2023. 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 This requirement also helps ensure we have the proper information needed to promptly pay your claims. 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. The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. Completed and signed attestations can be submitted by the physician to the Department of Health via secure email at CMS.ClinicalEligibilityScreening@flhealth.gov or via fax to 850-488-3813. Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved Please note that a new browser window will open. endstream endobj startxref Provider Enrollment - Florida CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. 2023 Accurate Biometrics, Inc. | All rights reserved. Limitations, co-payments and restrictions may apply. Community Care Plan - Home - ccpcares 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. % 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. Left navigation requires javascript to be enabled in your browser. 0000063183 00000 n Default Pay Multiple Service Locations, Referring The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. PML - Provider Master List. You can decide how often to receive updates. 10/31/22. 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 Enrollment Tracking Search feature has been updated to include application deficiency reasons. 3 0 obj 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. 2 Default Pay Multiple Service Locations, Facility 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. Sunshine Health is a managed care plan with a Florida Medicaid contract. Toll Free: (877) 423-4746. endstream endobj 269 0 obj <. 0000001572 00000 n AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. endstream endobj startxref 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. Provider. 0 People on Medicaid will get services using one or more of these plan types: Registered providers enrolled as provider type 97 MANAGED CARE TREATING PROVIDER - NON-MEDICAID. DXC will add the provider to the Florida Medicaid Management Information System (FLMMIS) and the Provider Master List, so that after the provider is paid encounters will successfully process in the FLMMIS. 0000026034 00000 n Please review the Scheduled Maintenance If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. x]moF a?J. "W%6TTofkG 49 37 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 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.

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