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. The Enrollment Tracking Search feature has been updated to include application deficiency reasons. 0000020302 00000 n Date: 10/31/22. . 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. Call your provider advocate for more information. The agency will be posting related updates to X12 837 companion guides soon. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. Default Pay Multiple Service Locations, Referring Limitations, co-payments and restrictions may apply. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. PLEASE CHECK SPELLING, SPACING, ATTENDING SERVICE ADDRESS IS INVALID- AHCA Find Medicaid Doctors, Dentists, and Specialists Find Medicaid Doctors, Dentists, and Specialists "To find doctors, dentists, and specialists in your community that serve Medicaid patients, go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a Choice Counselor." Download the free version of Adobe Reader. hb```e``@(2K.D8pA5agE7KU1xt40[ q(K a`di)>LL3a<2^-pcIr|n0\a:MH330;X]?H3Q1@ G/ 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 Use the, Verify your information matches what you submit on your claims. 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 In support of validation that a health care provider meets these requirements, AHCCCS publishes two listings as follows on a regular basis: AHCCCS Active, Registered Providers by NPI who may Refer, Order, Prescribe, or Attend ROPA Excepted Providers List (Residents, Interns, Pharmacists) Steps To Comply with ROPA During the Registration Extension 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 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. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS Please note that a new browser window will open. 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. Only eligible enrolled Organizational (Group) providers operating under the same Federal Employer Identification Number (FEIN/Tax ID), may enroll additional service locations. Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. 0000011496 00000 n 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. 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 Or start a search using ourFind A Providertool. This enhanced wizard allows Individual providers (Entity Type 1) to add additional service location addresses to their existing files. 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. 7s]]7~}qn{wVZFl)[Vj}v~{=~{[j v{a-V'::n?Igcml7,[ -vOx7Kfo%ZNoFv>Z[OX&xuYXXOqk |}`aHvo9~4q={K(92jo!5#42A\v_p \|GNMGn\, Cj`oHu_duxRR0g8Qmz$F# Y= XX;w_ZpcK+(' q&JXGD\Cw6 \hzp#y:Nj:JDZ> The Recipient Procedure Lookup is available from the Claims menu or the Eligibility menu. 49 37 AHCA requirements 0000026103 00000 n Secure .gov websites use HTTPSA Toll Free: (877) 423-4746. 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 INVALID, REFERRING 2 ZIP CODE IS MISSING/ 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 Primary: (404) 657-5468. 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. 0000026201 00000 n If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. 786 0 obj <> endobj 850-298-7123. A new application must be submitted if the ATN was terminated before March 2022. Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. Providers who fail to sign the agreement will be subject to audits and recoupment of funds associated with the minimum wage requirement. View the Master List (PDF). You will need Adobe Reader to open PDFs on this site. Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. 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. The Agency for Health Care Administration (Agency) and the Agency's fiscal agent, Gainwell Technologies (Gainwell), have enacted the NPI Crosswalk Elimination initiative to mitigate NPI Crosswalk data issues. Megamenu requires javascript to be enabled in your browser. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 0000000016 00000 n . The QRG Page has links to the NPI Self-Service Tool QRG, Address Maintenance Wizard QRG and other useful resources. AHCA - Agency for Health Care Administration. hbbd```b``A$"Y &$3&8d SIt+ https:// 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. 0000015958 00000 n Please contact the Public Records office for questions about the public records requests. stream All rights reserved. Medicaid Fair Hearing; %PDF-1.7 For additional assistance, please contact Provider Enrollment at 1-800-289-7799, Option 4. 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). 0000019903 00000 n Email Us. ( Sunshine Health is a managed care plan with a Florida Medicaid contract. The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. 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. Business Name Enter Business Name for Establishments or Last Name for Practitioner Last Name First Name City County Zip Code License Status following taxonomy edits are not new but will continue to pay and 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 FLSMPLY-CD-003934-22 July 2022 . You also have to meet Nursing Facility level of care. Health Plan Portal User Manual. This enhancement replaces the New Service Type or Address Request form that is currently used to request a secondary location. %%EOF To enroll, you must have an NPI. 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. Out-of-State Registered providers enrolled as provider type 16 RESIDENTIAL AND FREESTANDING PSYCHIATRIC FACILITY. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. E I IW42@ Va~(i&^ L ,d(SJ{K"K7(52jT^FT,48P$1XT4k8e. Please try your search again with other search values. Privacy Policy. | D61, Referring, Ordering, Prescribing, and Attending Providers, Known Issues and Informational Items List, Holiday Office 0000017333 00000 n X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . 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. Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. % 2 Default Pay Multiple Service Locations, Facility 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. Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. The benefit information provided is a brief summary, not a complete description of benefits. Medicaid & CHIP Enrollment Data. 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 The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. a. the Master Provider file (MPF), a Texas Medicaid and Healthcare Partnership (TMHP) data warehouse-derived pool of provider records, b. the TMHP member-facing directory or "online provider lookup" (OPL) on the TMHP website, c. the provider reconcile files, a MAXIMUS data warehouse-derived pool of provider records, and d. Provider. 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. 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). Complete Enrollment for Your Medicaid ID. 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. 0000041273 00000 n 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? Complete one or more search fields. Action Required: Please complete the application wizard with AHCA online to renew and/or complete your Medicaid ID registration. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the r>LFoc6rw,0-ccIp3@IqusJ. 0000014536 00000 n Monday - Friday. COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. 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. Sunshine Health is a managed care plan with a Florida Medicaid contract. Default Pay Multiple Service Locations, Attending 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. The Agency will implement the revised PML and PPL formats on February 25th, 2022. endobj Default Pay Multiple Service Locations, Performing You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. 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 Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. 0000017512 00000 n Default Pay Multiple Service Locations, Referring 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. 0000001417 00000 n endstream endobj startxref endstream endobj startxref 10/31/22. 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. 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 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. Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. 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. means youve safely connected to the .gov website. 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. This impacted providers who had more than one state Medicaid ID. 0000019074 00000 n b\[py @ W9v|L39Ri@ L( 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.