document for a comprehensive list of 2023 scheduled maintenance dates. 304 0 obj <>stream | r]G(c>|2]eVg\PP 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 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. The benefit information provided is a brief summary, not a complete description of benefits. Claim Status Request and Response | CMS 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. The Recipient Procedure Lookup is available from the Claims menu or the Eligibility menu. 786 0 obj <> endobj Out-of-State Registered providers enrolled as provider type 16 RESIDENTIAL AND FREESTANDING PSYCHIATRIC FACILITY. Download the free version of Adobe Reader. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. October 8, 2021, a new self . We recommend you use a certified browser to ensure that the application functions as expected. The QRG Page has links to the NPI Self-Service Tool QRG, Address Maintenance Wizard QRG and other useful resources. stream 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- This impacted providers who had more than one state Medicaid ID. Claim submissions . AHCA will reopen ATNs for ALF providers who previously submitted an application that was terminated for incomplete documentation within the last six months. The process for provisional provider enrollment will be located on the New Medicaid Providers page, under the Provider Services menu. Provider, ROPA Taxonomy Is Missing Dtl Ordering 268 0 obj <> endobj hbbd```b``A$"Y &$3&8d SIt+ COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. Fort Lauderdale, Florida. PDF NPI crosswalk logic change updates - Simply Healthcare Plans AHCA requirements 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. Email Advisory | The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. 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 Sunshine Health is a managed care plan with a Florida Medicaid contract. Default Pay Multiple Service Locations, Attending Complete one or more search fields. 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. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 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). 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. View the Master List (PDF). Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- If you dont take action by your PML expiration date, you will be terminated from the Sunshine Health network on your PML expiration date. 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. 2023 Accurate Biometrics, Inc. | All rights reserved. No records found. Search Providers | Florida Department of Health 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. They are located on the AHCA public web portal under Provider Services/EDI/Companion guides. 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. (Use fewer fields to produce more results: See Search Help), Privacy Statement | 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. 0000017333 00000 n Changes will impact the process for registering, validating, and correcting new and existing provider information. Closure document for a comprehensive list of 2023 scheduled holidays. We can help. 0000025810 00000 n 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. Privacy Policy. This enhancement replaces the New Service Type or Address Request form that is currently used to request a secondary location. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS Provider Directories | Florida Medicaid | Sunshine Health 0000001036 00000 n Agency for Health Care Administration - Florida Default Pay Multiple Service Locations, Performing This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. 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 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. All Contacts. 0000018945 00000 n + 7B Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. If you are a provider meeting the criteria above and currently have an Application Tracking Number (ATN), AHCAs Provider Enrollment team will assist you in completing the process. 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. 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. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. PDF Florida Medicaid Health Care Alert - mytnfl.com `]).vpF'~E/\YY6GK%p &JjcsJ>z$W Kd2~@:_oVwL%JK1 v?x7#2B_>:f/7*jg*I3qnuDQgktd.S=~L\"#K7[G^3P0F>gf)8?&{y>h**|@lhb%85Px>jEff;HhCA?1gRhah8;?xuAk?yg?!yN?f~@oF 0000001251 00000 n Healthcare Provider Resource Guide Statewide (Regions 1 - Humana PLEASE CHECK SPELLING, SPACING, ATTENDING SERVICE ADDRESS IS INVALID- 0000042555 00000 n Florida State Medicaid Managed Care - Tab Window Title 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. 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. Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. PDF Provider Master List - Florida People on Medicaid will get services using one or more of these plan types: 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. Agency for Health Care Administration; P.O. Some providers are called essential providers. They provide care to members statewide. For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. 7:30 AM - 6 PM ET. 0000001417 00000 n Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. 826 0 obj <>stream Limitations, co-payments and restrictions may apply. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. To enroll, you must have an NPI. PDF Exceptions Process - LIBERTY Dental Plan 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 0 <> 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. Home | Florida Medicaid Web Portal Providers can submit claim status inquiries via the Medicare Administrative Contractors' provider Internet . Online Form. 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

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