The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. 0
PDF Provider Directory Data Quality - Texas Access the PML on AHA's Managed are site at - WellCare 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 Agency will implement the revised PML and PPL formats on February 25th, 2022. This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. Sign in with your Florida Medicaid account (use new password if you recently completed a reset). 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. FLSMPLY-CD-003934-22 July 2022 . To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. People on Medicaid will get services using one or more of these plan types: Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 4 0 obj
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Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. 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 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. . 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). Florida Medicaid Providers & Health Insurance Plans | Sunshine Health The Enrollment Tracking Search feature has been updated to include application deficiency reasons. 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. INVALID, REFERRING SERVICE ADDRESS IS INVALID-
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. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS
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This impacted providers who had more than one state Medicaid ID.
These enhancements will be available to Fully enrolled, Limited enrolled, and ROPA enrolled providers. Locate the appropriate taxonomy code that is . PLEASE CHECK SPELLING, SPACING, REFERRING 2 SERVICE ADDRESS IS INVALID-
The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. 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. endstream
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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. Please note that a new browser window will open. Example: ME99999 or ME069999. Please try your search again with other search values. 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.
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Limitations, co-payments and restrictions may apply. Community Care Plan - Home - ccpcares 0000001251 00000 n
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Please review the Known Issues and Informational Items List for details listed related to the MMIS. Default Pay Multiple Service Locations, Performing
Email Us. Humana Healthy Horizons in Florida is a Medicaid product of Humana Medical Plan Inc. LC17772FL0522 (FLHKCNLEN) Healthcare Provider Resource Guide - Statewide (Regions 1 through 11) Humana Healthy Horizons in Florida provider web page Your Humana Healthy Horizons in Florida provider website has a variety of materials and resources to help your Humana + 7B PDF Claim Issues Tip Sheet: Billing of Provider Data Elements-Taxonomy/PML TIN - Tax ID Number . Health plans can access the sample test files with the new layout on the Submission Information page of the Florida Medicaid Web Portal. Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. Claims and encounters passed whenever a one-to-one match was found. For more information contact the Managed Care Plan. or (Use fewer fields to produce more results: See Search Help), Privacy Statement |
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. <>
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. 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. 10/31/22. Toll Free: (877) 423-4746. Florida State Medicaid Managed Care - Health - Health Plans and Program Changes will impact the process for registering, validating, and correcting new and existing provider information. 0000063950 00000 n
Community Care Plan is owned by South Florida's most experienced names in health care: Broward Health (North Broward Hospital District) and Memorial Healthcare System (South Broward Hospital District). For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces . 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). 850-298-7123. hbbd```b``65 d3E`rX$LX$XDNL q%VV@&F`Jg-@ T
Community Care Plan (CCP) is a Provider Service Network (PSN) in Broward County. 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). 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. 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 0000022399 00000 n
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 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 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
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Registered providers enrolled as provider type 97 MANAGED CARE TREATING PROVIDER - NON-MEDICAID. Have questions? Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. Limitations, co-payments and restrictions may apply. following taxonomy edits are not new but will continue to pay and
Please review the Scheduled Maintenance
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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. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 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. Florida | Medicaid 2023 Accurate Biometrics, Inc. | All rights reserved. View the Master List (PDF). Default Pay Multiple Service Locations, Other
The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. Provider. 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. %
PML - 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. Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. Sign up to get the latest information about your choice of CMS topics. 0000019453 00000 n
For additional assistance, please contact Provider Enrollment at 1-800-289-7799, Option 4. Procedure code lookups are now available on the Florida Medicaid Secure Web Portal via the new Recipient Procedure Lookup self-service tool. Agency for Health Care Administration; P.O. List of CPT/HCPCS Codes | CMS - Centers for Medicare & Medicaid Services Home | Florida Medicaid Web Portal document for a comprehensive list of 2023 scheduled maintenance dates. 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. 0000074223 00000 n
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Thank you for choosing the Children's Medical Services (CMS) Managed Care Plan for your health care needs. | r]G(c>|2]eVg\PP YouTube page for Georgia Medicaid; How can we help? Providers | Georgia Medicaid Complete Enrollment for Your Medicaid ID | Sunshine Health Any provider that has a payment suspension based on a credible allegation of fraud within the last 10 years,[23] Any provider excluded within the past 10 years by HHS-OIG or an SMA,[24, 25] Any provider that has a qualifying Medicaid overpayment,[ 26] The provider is enrolling within 6 months of the date of the lifting of a
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