florida medicaid provider master list florida medicaid provider master list

Florida State Medicaid Managed Care - Tab Window Title The New Service Type or Address Request form will no longer be processed. Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. 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. State Profiles | Medicaid b\[py @ W9v|L39Ri@ L( This requirement also helps ensure we have the proper information needed to promptly pay your claims. An official website of the United States government 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 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. Fort Lauderdale, Florida. YouTube page for Georgia Medicaid; How can we help? 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). 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. 4 0 obj COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. Default Pay Multiple Service Locations, Referring AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. Agency for Health Care Administration; P.O. Master List of Durable Medical Equipment, Prosthetics, Orthotics - CMS 268 0 obj <> endobj | D61, Referring, Ordering, Prescribing, and Attending Providers, Known Issues and Informational Items List, Holiday Office 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. PDF Exceptions Process - LIBERTY Dental Plan 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. Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. Closure document for a comprehensive list of 2023 scheduled holidays. 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. 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 0000025923 00000 n 0000017333 00000 n 10/31/22. In accordance with 42 Code of Federal Regulations 455.410(b), all ordering or referring physicians, or other professionals providing services to Medicaid recipients must be enrolled with Florida Medicaid. 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. Failure to keep an active status disqualifies providers from receiving payment. Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older. ROPA - azahcccs.gov The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. The benefit information provided is a brief summary, not a complete description of benefits. 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 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). 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. 0000041273 00000 n Community Care Plan - Home - ccpcares 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 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- 0000074223 00000 n 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. Please visit the Hurricane Preparedness page frequently to remain up-to-date with the latest information as it is made available. To enroll, you must have an NPI. (Updated 02/15/2023). 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. Medicaid & CHIP Enrollment Data. website belongs to an official government organization in the United States. Florida Medicaid: Claim and AHCA data must match State of Illinois | Provider Directory: Complete Provider List 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. Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The Agency will implement the revised PML and PPL formats on February 25th, 2022. The PML and PPL revised layouts will accommodate the new NPI Mapping Logic, which will be implemented on March 1st, 2022. lock Providers can access this information on the Enrollment Status page under the Provider Services tab. providers that render services to eligible Medicaid recipients. For additional information and the latest updates from the Agency for Health Care Administration (Agency), please visit the COVID-19 page on the Agency's website. Please be sure to submit all five pages of the attestation. Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. 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. . They are located on the AHCA public web portal under Provider Services/EDI/Companion guides. Download the free version of Adobe Reader. 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. 0000001251 00000 n hb```f``f`a`,gf@ a+P dk3~Gx0m`c``v[@q4#RrhUn 1 (sHslFi\X By using this site, you agree to the Florida ORI Numbers and Professions - Accurate Biometrics The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. Please contact the Public Records office for questions about the public records requests. To allow providers to prepare for changes related to this initiative, the Agency has moved the implementation date to 3/1/2022. X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . Or start a search using ourFind A Providertool. <> 0000041995 00000 n %PDF-1.7 This enhancement replaces the New Service Type or Address Request form that is currently used to request a secondary location. 0000073968 00000 n Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. 7:30 AM - 6 PM ET. 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 hbbd```b``65 d3E`rX$LX$XDNL q%VV@&F`Jg-@ T Locate the appropriate taxonomy code that is . Thank you for choosing the Children's Medical Services (CMS) Managed Care Plan for your health care needs. https:// The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. 0000019903 00000 n Secure .gov websites use HTTPSA ( 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. ACCESSING PROVIDER MASTER LIST - PDF Free Download 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. 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. Provider Directories | Florida Medicaid | Sunshine Health 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. %PDF-1.4 % AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. Limitations, co-payments and restrictions may apply. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS 0000063950 00000 n AHCA will reopen ATNs for ALF providers who previously submitted an application that was terminated for incomplete documentation within the last six months. or 0000063183 00000 n FL DOH MQA Search Portal | License Verification 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. Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. Registration | Florida Medicaid Web Portal Toll Free: (877) 423-4746. 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. JavaScript required - Sign In 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 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. A new application must be submitted if the ATN was terminated before March 2022. The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. Florida | Medicaid 0000048907 00000 n Provider Enrollment - Florida 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. 0000019453 00000 n 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). 0000041535 00000 n Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Some providers are called essential providers. They provide care to members statewide. 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. 0000026103 00000 n 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. Health Plan Portal User Manual. State Profiles Every state's Medicaid and CHIP program is changing and improving - most states are expanding coverage for low-income adults; all states are modernizing their Medicaid/CHIP eligibility, enrollment and renewal processes and systems, and taking advantage of many of the new flexibilities provided by the Affordable Care Act. 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. Florida Department of Health | Division of Medical Quality Assurance Search Services, To verify a Nurse Licensure Compact Multi-State RN or LPN License, access. 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. To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. NPI - National Provider Identifier. Default Pay Multiple Service Locations, Other Medicaid Provider Enrollment Requirements Fact Sheet FLSMPLY-CD-003934-22 July 2022 . The Managed Care pages provide managed care plans with helpful information and tools related to fiscal agent file exchange, guidance for understanding data, and reports. 0 INVALID, REFERRING SERVICE ADDRESS IS INVALID- Email Us. 0000063432 00000 n We can help. ) 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. Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status means youve safely connected to the .gov website. 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. Sunshine Health is a managed care plan with a Florida Medicaid contract. .gov 0000025810 00000 n The Florida Medicaid Web Portal supports the Microsoft Edge Chromium browser which can be downloaded from the Microsoft website. Questions? Change of Address (COA) Wizard: The current COA Wizard will be enhanced to allow Individual providers (Entity Type 1) to add additional service location addresses to their existing files. following taxonomy edits are not new but will continue to pay and This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. 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. document for a comprehensive list of 2023 scheduled maintenance dates. 0000042555 00000 n endstream endobj startxref Florida State Offices Responsible for State Exclusions and Program Only eligible enrolled Organizational (Group) providers operating under the same Federal Employer Identification Number (FEIN/Tax ID), may enroll additional service locations. endstream endobj startxref 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. 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 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 Florida Medicaid. 2 0 obj You must include the following information for billing and rendering providers when submitting claims: What you need to do Out-of-State Registered providers enrolled as provider type 16 RESIDENTIAL AND FREESTANDING PSYCHIATRIC FACILITY. 0000022399 00000 n PDF Claim Issues Tip Sheet: Billing of Provider Data Elements-Taxonomy/PML endstream endobj 787 0 obj <>/Metadata 53 0 R/Pages 784 0 R/StructTreeRoot 74 0 R/Type/Catalog>> endobj 788 0 obj <>/MediaBox[0 0 612 792]/Parent 784 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 789 0 obj <>stream <> D2 r1@&F9`00Ig` \ Call your provider advocate for more information. Provider Links - Florida The QRG Page has links to the NPI Self-Service Tool QRG, Address Maintenance Wizard QRG and other useful resources. Providers and Agents. | r]G(c>|2]eVg\PP 0000019074 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.