florida medicaid provider master list

Registration | Florida Medicaid Web Portal Address Maintenance Wizard: The current Change of Address (COA) Wizard has been renamed to the Address Maintenance Wizard. 10/31/22. Need access to the UnitedHealthcare Provider Portal? %PDF-1.4 % Monday - Friday. 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. 0000041970 00000 n Default Pay Multiple Service Locations, Performing D2 r1@&F9`00Ig` \ 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, Statewide Medicaid Managed Care Registered Provider Initiative form (PDF), medicaideligibilityoutreach@ahca.myflorida.com, Call 1-800-289-7799, Option 4 for any additional provider enrollment questions. YouTube page for Georgia Medicaid; How can we help? 0000025810 00000 n Failure to keep an active status disqualifies providers from receiving payment. 0000063183 00000 n [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. You will need Adobe Reader to open PDFs on this site. 0000041535 00000 n On the Florida Medicaid Web Portal you can access the Provider Master List. 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. document for a comprehensive list of 2023 scheduled maintenance dates. All rights reserved. Home | Florida Medicaid Web Portal 0000042555 00000 n For Providers Addiction Recovery and Treatment Services, Behavioral Health, Dental, Foster Care, High Needs Support, Long Term Care, Managed Care, Maternal and Child Health, Pharmacy Services and more DMAS - Department of Medical Assistance Services Cardinal CareVirginia's Medicaid Program Department of Medical Assistance Services Menu Sitemap 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. Default Pay Multiple Service Locations, Attending Default Pay Multiple Service Locations, Referring NPI Directory State of Florida - NPI Profile 0 Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. Thank you for choosing the Children's Medical Services (CMS) Managed Care Plan for your health care needs. Detail Default Pay Multiple Service Locations, Ordering Provider, ROPA Taxonomy Is Missing Dtl Ordering 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 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. Agency for Health Care Administration; P.O. Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. Default Pay Multiple Service Locations, Referring Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . Use the, Verify your information matches what you submit on your claims. 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. Please review the Scheduled Maintenance Only eligible enrolled Organizational (Group) providers operating under the same Federal Employer Identification Number (FEIN/Tax ID), may enroll additional service locations. We recommend you use a certified browser to ensure that the application functions as expected. Provider Directories | Florida Medicaid | Sunshine Health You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. 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. 0000018945 00000 n Please try your search again with other search values. Florida Medicaid will pay for medically necessary services provided to recipients diagnosed with COVID-19, regardless of whether the provider is located in-state or out-of-state. 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. October 8, 2021, a new self . Sunshine Health is a managed care plan with a Florida Medicaid contract. Default Pay Multiple Service Locations, Referring Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. Changes will impact the process for registering, validating, and correcting new and existing provider information. For instructions, see ourFind A Provider Step-by-Step Guide (PDF). ) Call Us. 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 Locate the appropriate taxonomy code that is . Have questions? PML - Provider Master List. %%EOF 0000063432 00000 n 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 786 0 obj <> endobj 850-298-7123. hb```f``f`a`,gf@ a+P dk3~Gx0m`c``v[@q4#RrhUn 1 (sHslFi\X 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. Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older. On June 2, 2022, Governor Ron DeSantis signed the Freedom First budget for State Fiscal Year (SFY) 2022-2023. This is done through the provision of quality services to meet the care needs of . Master List of Durable Medical Equipment, Prosthetics, Orthotics - CMS For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . 0000019074 00000 n Managed Care Provisional Out-of-network Provider Enrollment form to DXC Technology, at FL-emergent-enroll@dxc.com. NPI - National Provider Identifier. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. Access the PML on AHA's Managed are site at - WellCare This impacted providers who had more than one state Medicaid ID. 304 0 obj <>stream Share sensitive information only on official, secure websites. 0 Florida ORI Numbers and Professions - Accurate Biometrics AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. Health plans can access the sample test files with the new layout on the Submission Information page of the Florida Medicaid Web Portal. Sign in with your Florida Medicaid account (use new password if you recently completed a reset). 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. Example: ME99999 or ME069999. The Florida Medicaid Web Portal supports the Microsoft Edge Chromium browser which can be downloaded from the Microsoft website. Registered providers enrolled as provider type 97 MANAGED CARE TREATING PROVIDER - NON-MEDICAID. Secure .gov websites use HTTPSA State Profiles | Medicaid To become a Medicare provider and file Medicare claims, you must first enroll in the Medicare program. 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. If you would like to receive information regarding providers that were sanctioned by the Agency prior to July 1, 2009, please contact our Public Records Office at (850) 412-3688. 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. Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved 2023 Accurate Biometrics, Inc. | All rights reserved. %PDF-1.7 AHCA Find Medicaid Doctors, Dentists, and Specialists - Florida For additional assistance, please contact Provider Enrollment at 1-800-289-7799, Option 4. This requirement also helps ensure we have the proper information needed to promptly pay your claims. The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. 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 0000073968 00000 n 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. 0000048537 00000 n 0000048276 00000 n See the Florida Medicaid Provider Registration Guidefor directions for successfully completing the form. TIN - Tax ID Number . To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. The QRG Page has links to the NPI Self-Service Tool QRG, Address Maintenance Wizard QRG and other useful resources. 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. Heres how you know. This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. 0000041995 00000 n Complete one or more search fields. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. Call your provider advocate for more information. No records found. <> Florida Medicaid - Sign In from pg. 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 in the NLC Quick Reference Guide (QRG), located in the Add Additional Locations section of the Enrollment Forms page. Florida | Medicaid Florida State Medicaid Managed Care - Tab Window Title Managed Care Plan with a Florida Medicaid contract. Florida State Medicaid Managed Care - Health - Health Plans and Program 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. 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 x]moF a?J. "W%6TTofkG PDF Provider Master List - Florida PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID- 49 37 This enhancement replaces the New Service Type or Address Request form that is currently used to request a secondary location. 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 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. Provider Services - Florida 2 Default Pay Multiple Service Locations, Facility + 7B 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. 0000026201 00000 n Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. PDF Exceptions Process - LIBERTY Dental Plan Health Plan Portal User Manual. (Updated 02/15/2023). 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. 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. Florida Medicaid. 0000001251 00000 n Send a Message. hmo6 Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status Action Required: Please complete the application wizard with AHCA online to renew and/or complete your Medicaid ID registration. Find a Provider Contact Us. Claims and encounters passed whenever a one-to-one match was found. Community Care Plan - Home - ccpcares b\[py @ W9v|L39Ri@ L( 0000025923 00000 n NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. . 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. Disclaimer | AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. ROPA - azahcccs.gov Additional information on the status of your Florida Medicaid enrollment application is now available through self-service on the public Web Portal. Complete Enrollment for Your Medicaid ID | Sunshine Health 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. 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. Questions? The benefit information provided is a brief summary, not a complete description of benefits. AHCA will reopen ATNs for ALF providers who previously submitted an application that was terminated for incomplete documentation within the last six months. NPI Registration Form: The NPI Registration Form will be discontinued with the following exceptions: NPI to Medicaid ID Search Engine: The existing tool will be enhanced and will be accessible via the secure Web Portal. 826 0 obj <>stream T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL Left navigation requires javascript to be enabled in your browser. 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. Toll Free: (877) 423-4746. Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. Providers can access this information on the Enrollment Status page under the Provider Services tab. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. For more information contact the Managed Care Plan. 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. 268 0 obj <> endobj INVALID, REFERRING 2 ZIP CODE IS MISSING/ 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. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the 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 The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. Please be sure to submit all five pages of the attestation. FL DOH MQA Search Portal | License Verification Several of these new CARC/RARC combinations have been revised and will no longer cause a denial on encounter submissions. 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. 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. This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. _b>? 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/ List of CPT/HCPCS Codes | CMS - Centers for Medicare & Medicaid Services 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. 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. Please review the Holiday Office Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. endstream endobj startxref They are located on the AHCA public web portal under Provider Services/EDI/Companion guides. Provider Links - Florida The New Service Type or Address Request form will no longer be processed. 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. By using this site, you agree to the PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS Please note that a new browser window will open. If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. Provider Enrollment - Florida 0000001417 00000 n 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. PDF NPI crosswalk logic change updates - Simply Healthcare Plans Medicaid & CHIP Enrollment Data. Download the free version of Adobe Reader. Provider Directories | Florida Medicaid | Sunshine Health PDF Claim Issues Tip Sheet: Billing of Provider Data Elements-Taxonomy/PML 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 Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. For more information contact the Managed Care Plan. 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. 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? PLEASE CHECK SPELLING, SPACING. Providers and Agents. COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. 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. lock 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. 1 0 obj 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. r>LFoc6rw,0-ccIp3@IqusJ. | Illinois Fingerprint Vendor Agency (license # 262.000016) Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1.

florida medicaid provider master list 2023