florida medicaid provider master list

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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. Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims % 0000015958 00000 n The list of certified browsers can be found on the. ( Sunshine Health is a managed care plan with a Florida Medicaid contract. 0000048276 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. 0000001251 00000 n hb```e``@(2K.D8pA5agE7KU1xt40[ q(K a`di)>LL3a<2^-pcIr|n0\a:MH330;X]?H3Q1@ G/ Additional information on the status of your Florida Medicaid enrollment application is now available through self-service on the public Web Portal. https:// AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. You must include the following information for billing and rendering providers when submitting claims: What you need to do 0000014536 00000 n 3 0 obj 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. Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. Changes will impact the process for registering, validating, and correcting new and existing provider information. Limitations, co-payments and restrictions may apply. 0000063432 00000 n T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL The alphabetical listing of providers by specialty allows you to easily locate all the providers in the area that have the same scope of practice. Florida Medicaid. D2 r1@&F9`00Ig` \ This enhanced wizard allows Individual providers (Entity Type 1) to add additional service location addresses to their existing files. Sunshine Health is a managed care plan with a Florida Medicaid contract. To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. %%EOF 0000019903 00000 n *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! You will need Adobe Reader to open PDFs on this site. 0000025810 00000 n Providers who fail to sign the agreement will be subject to audits and recoupment of funds associated with the minimum wage requirement. 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. 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 Toll Free: (877) 423-4746. FLSMPLY-CD-003934-22 July 2022 . 4 0 obj 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). An updated Provider Master List tip sheet is now available on the Managed Care Support section of the 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 benefit information provided is a brief summary, not a complete description of benefits. b\[py @ W9v|L39Ri@ L( %PDF-1.7 X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . Heres how you know. AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. 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 7s]]7~}qn{wVZFl)[Vj}v~{=~{[j v{a-V'::n?Igcml7,[ -vOx7Kfo%ZNoFv>Z[OX&xuYXXOqk |}`aHvo9~4q={K(92jo!5#42A\v_p \|GNMGn\, Cj`oHu_duxRR0g8Qmz$F# Y= XX;w_ZpcK+(' q&JXGD\Cw6 \hzp#y:Nj:JDZ> Send a Message. Transactions submitted with a From Date of Service of March 1, 2022, or later must use a valid taxonomy associated with the providers specialty. Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. hmo6 A new application must be submitted if the ATN was terminated before March 2022. . If your Medicaid ID shows an enrollment type of Registered status on AHCAs Provider Master List (PML), claims received under your NPI will deny for Medicaid ineligibility. 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 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. For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: [email protected]. Largest Cities in Florida Miami 52,853 Tampa 26,198 Orlando 24,833 Jacksonville 24,345 Gainesville 13,594 Hialeah 10,407 Fort Myers 8,132 West Palm Beach 7,683 Sarasota 7,607 Boca Raton 7,591 Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. You can decide how often to receive updates. 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. 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). endstream endobj 269 0 obj <. An official website of the United States government 0000063183 00000 n 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. This requirement follows the mandate the AHCA enacted on March 1, 2022, requiring all healthcare professionals providing care to Medicaid enrollees to include specific identifiers when filing claims. 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. (cont. 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. 0000048907 00000 n Default Pay Multiple Service Locations, Performing 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 Download the free version of Adobe Reader. 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. 0000026034 00000 n Providers can access this information on the Enrollment Status page under the Provider Services tab. This is done through the provision of quality services to meet the care needs of . Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 304 0 obj <>stream 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. NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. 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 Medicaid & CHIP Enrollment Data. 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 [email protected] Mailing Address Office of the CMS Managed Care Plan 4052 Bald Cypress Way, Bin A06 Tallahassee, FL 32399 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. Closure document for a comprehensive list of 2023 scheduled holidays. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Detail Default Pay Multiple Service Locations, Ordering 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. Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. stream Claims with a From Date of Service of March 1, 2022, or after should use the ZIP+4 associated with the provider service location address. Share sensitive information only on official, secure websites. By using this site, you agree to the 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. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. | r]G(c>|2]eVg\PP 0000001036 00000 n 0000001417 00000 n Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. Default Pay Multiple Service Locations, Other 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. 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/ No records found. 0000048537 00000 n trailer <<9525EF5C7FA24921844CA5259BD404D3>]/Prev 78233/XRefStm 1251>> startxref 0 %%EOF 85 0 obj <>stream Several of these new CARC/RARC combinations have been revised and will no longer cause a denial on encounter submissions. This requirement also helps ensure we have the proper information needed to promptly pay your claims. 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. Email Us. 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. 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. These enhancements will be available to Fully enrolled, Limited enrolled, and ROPA enrolled providers. 0000019074 00000 n 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 All rights reserved. 0000041273 00000 n 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. 2 0 obj 49 37 Left navigation requires javascript to be enabled in your browser. Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older. The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. Revised CMS-1500 Claim Form (front . The following essential providers are part of Sunshine Healths network and are available to all members: You will need Adobe Reader to open PDFs on this site. On the Florida Medicaid Web Portal you can access the Provider Master List. 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. 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. The following self-service features are now available: NPI Self-Service Feature: A new NPI self-service tool is available to all providers via the secure Web Portal. And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. 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. COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. endobj 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. As part of the Registered Provider Enrollment Initiative, the Agency for Health Care Administration (AHCA) is offering enrollment assistance to Skilled Nursing Facilities, Assisted Living Facilities (ALFs) and Residential and Freestanding Psychiatric Facilities that are actively seeking compliance with the Registered Provider Initiative. Agency for Health Care Administration; P.O. The Please review the Known Issues and Informational Items List for details listed related to the MMIS. 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. . 0000025923 00000 n The PML and PPL revised layouts will accommodate the new NPI Mapping Logic, which will be implemented on March 1st, 2022. 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. 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. For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . 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. Megamenu requires javascript to be enabled in your browser. Some providers are called essential providers. They provide care to members statewide. <>/Metadata 210 0 R/ViewerPreferences 211 0 R>> 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. 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. The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Provider. 826 0 obj <>stream 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. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. Need access to the UnitedHealthcare Provider Portal? CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. 0 endstream endobj startxref 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 Providers and Agents. 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. 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 $15.00 an hour. 0000018945 00000 n 0000022399 00000 n The following new CARC/RARC combinations will pay and post on qualifying X12 837 encounters via 835 transactions when multiple provider IDs are matched to the submitted data: Billing 268 0 obj <> endobj Out-of-State Registered providers enrolled as provider type 16 RESIDENTIAL AND FREESTANDING PSYCHIATRIC FACILITY. If the provider is not a fully enrolled provider (noted with "Y" under Registered Provider Column on Provider Master List) please contact WellCare at: 1-866-334- Medicaid Fair Hearing; We update the Code List to conform to the most recent publications of CPT and HCPCS . document for a comprehensive list of 2023 scheduled maintenance dates. Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. The Florida Medicaid Taxonomy Guide, found under Enrollment Forms on the Florida Medicaid Web Portal, open_in_new identifies taxonomies that correlate to provider types and specialties FLMMIS Provider Enrollment open_in_new lists provider types Claims, Billing and Payments on UnitedHealthcare Provider Portal to review and resubmit claims Questions? If the provider is a fully enrolled Medicaid provider (noted with "N" under Registered Provider column on Provider Master List) please contact AHCA at: 1-800-289-7799 Option 4. ii. Primary: (404) 657-5468. post on health plan encounter submissions. This impacted providers who had more than one state Medicaid ID. 2023 Accurate Biometrics, Inc. | All rights reserved. Default Pay Multiple Service Locations, Referring Providers can submit claim status inquiries via the Medicare Administrative Contractors' provider Internet . (Use fewer fields to produce more results: See Search Help), Privacy Statement | Under the Managed Care menu, you will want to select Provider Master List, which can be found under the Registration column (third from the right). 2 Default Pay Multiple Service Locations, Facility hb``Pd``e```a@@q%4IT$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 that render services to eligible Medicaid recipients. Managed Care Provisional Out-of-network Provider Enrollment form to DXC Technology, at [email protected]. Complete one or more search fields. or Disclaimer | <> Download the free version of Adobe Reader. 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. 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 %PDF-1.4 % following taxonomy edits are not new but will continue to pay and Call your provider advocate for more information. PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- INVALID, REFERRING 2 ZIP CODE IS MISSING/ E I IW42@ Va~(i&^ L ,d(SJ{K"K7(52jT^FT,48P$1XT4k8e. 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. 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. 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. People on Medicaid will get services using one or more of these plan types: Please review the Holiday Office Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . (Updated 02/15/2023). All Contacts. Completed and signed attestations can be submitted by the physician to the Department of Health via secure email at [email protected] or via fax to 850-488-3813. Sign in with your Florida Medicaid account (use new password if you recently completed a reset). . INVALID- PLEASE CHECK SPELLING, SPACING, ORDERING SERVICE ADDRESS IS INVALID- Email Advisory | Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. 0000073968 00000 n 0000011496 00000 n Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status

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