Send a Message. Effective February 25, 2022, the following self-service features will be available: NPI Self-Service: The new NPI self-service feature will allow providers to update or add a new NPI to the Medicaid provider ID associated to the account the provider is logged into. r>LFoc6rw,0-ccIp3@IqusJ. Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . Please review the Scheduled Maintenance By using this site, you agree to the Example: ME99999 or ME069999. We recommend you use a certified browser to ensure that the application functions as expected. Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims hmo6 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. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS 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. We can help. 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. If you would like to search for a complete list of licensed providers, please visit our data portal. 2 Default Pay Multiple Service Locations, Facility Transactions submitted with a From Date of Service of March 1, 2022, or later must use a valid taxonomy associated with the providers specialty. 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. Address Maintenance Wizard: The current Change of Address (COA) Wizard has been renamed to the Address Maintenance Wizard. The PML and PPL revised layouts will accommodate the new NPI Mapping Logic, which will be implemented on March 1st, 2022. 0000001036 00000 n Please review the Holiday Office Managed Care Provisional Out-of-network Provider Enrollment form to DXC Technology, at FL-emergent-enroll@dxc.com. Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. 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. FLSMPLY-CD-003934-22 July 2022 . Left navigation requires javascript to be enabled in your browser. Health Plan Portal User Manual. 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. The benefit information provided is a brief summary, not a complete description of benefits. COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. | Illinois Fingerprint Vendor Agency (license # 262.000016) To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. Agency for Health Care Administration; P.O. 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? Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. An official website of the United States government Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. Need access to the UnitedHealthcare Provider Portal? 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 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. 0000024293 00000 n %%EOF 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. | D61, Referring, Ordering, Prescribing, and Attending Providers, Known Issues and Informational Items List, Holiday Office 0000015958 00000 n Secure .gov websites use HTTPSA Complete Enrollment for Your Medicaid ID. 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). Limitations, co-payments and restrictions may apply. PLEASE CHECK SPELLING, SPACING. D2 r1@&F9`00Ig` \ View the Master List (PDF). 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. 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. See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. Default Pay Multiple Service Locations, Referring The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Megamenu requires javascript to be enabled in your browser. Default Pay Multiple Service Locations, Attending On the Florida Medicaid Web Portal you can access the Provider Master List. Closure, 835 | Florida Medicaid Web Portal (flmmis.com), healthplan.support@gainwelltechnologies.com, Medicaid Provider Minimum Wage Requirements page, Florida Medicaid Agency for Health Care Administration, Florida Medicaid Health Information Network, Florida Medicaid Health Care Alerts Subscription, Centers for Medicare and Medicaid Services (CMS), Florida Health Finder - Consumer Information, You are using a browser that does not support the features required for use with this web application (JavaScript not enabled). To become a Medicare provider and file Medicare claims, you must first enroll in the Medicare program. Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. %PDF-1.5 % 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 endobj Default Pay Multiple Service Locations, Referring There are three different programs that makeup the Statewide Medicaid Managed Care Managed Medical Assistance (MMA) Program, Long-term Care (LTC) Program, and Dental Program Learn More About MMA and LTC Learn More About Dental 850-298-7123. . Changes will impact the process for registering, validating, and correcting new and existing provider information. Find a Provider Contact Us. Some providers are called essential providers. They provide care to members statewide. 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 Some providers may not perform certain services based on religious or moral beliefs. AHCA requirements The Enrollment Tracking Search feature has been updated to include application deficiency reasons. If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. 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. AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. Privacy Policy. 0000041535 00000 n 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. 0000000016 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. 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. Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. INVALID, REFERRING 2 ZIP CODE IS MISSING/ Several of these new CARC/RARC combinations have been revised and will no longer cause a denial on encounter submissions. Please contact the Public Records office for questions about the public records requests. 0000063183 00000 n Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. 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. 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). This enhanced wizard allows Individual providers (Entity Type 1) to add additional service location addresses to their existing files. or 786 0 obj <> endobj 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.