florida medicaid provider master list florida medicaid provider master list

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. Some providers may not perform certain services based on religious or moral beliefs. The list of certified browsers can be found on the. 850-298-7123. 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 0000063432 00000 n Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. This list includes detailed information about a provider's type, specialty, NPI, and Medicaid status. You also have to meet Nursing Facility level of care. 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. Medical Services Covered by Florida Medicaid Florida Medicaid covers a variety of medical services. 0000001417 00000 n Transactions submitted with a From Date of Service of March 1, 2022, or later must use a valid taxonomy associated with the providers specialty. Find a Provider Contact Us. 0000014536 00000 n 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. Closure document for a comprehensive list of 2023 scheduled holidays. An official website of the United States government 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 The Agency will implement the revised PML and PPL formats on February 25th, 2022. Example: ME99999 or ME069999. The Agency has posted new NPI Crosswalk Enhancement guidance that is located on the AHCA public Web Portal under Agency Initiatives/NPI Crosswalk Enhancement. We can help. 0000001251 00000 n Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved 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 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. Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. The process for provisional provider enrollment will be located on the New Medicaid Providers page, under the Provider Services menu. PDF NPI crosswalk logic change updates - Simply Healthcare Plans lock To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. 0000074223 00000 n 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. 268 0 obj <> endobj 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. 3 0 obj PDF Florida Medicaid Health Care Alert - mytnfl.com 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 Failure to keep an active status disqualifies providers from receiving payment. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the 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. 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$S4F. 0000013101 00000 n 0000018945 00000 n Sign up to get the latest information about your choice of CMS topics. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. The Agency for Health Care Administration (Agency) would like to announce the availability of the Provider Master List (PML) and Pending Provider List (PPL) test files. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. Closure, 835 | Florida Medicaid Web Portal (flmmis.com), healthplan.support@gainwelltechnologies.com, Medicaid Provider Minimum Wage Requirements page, Florida Medicaid Agency for Health Care Administration, Florida Medicaid Health Information Network, Florida Medicaid Health Care Alerts Subscription, Centers for Medicare and Medicaid Services (CMS), Florida Health Finder - Consumer Information, You are using a browser that does not support the features required for use with this web application (JavaScript not enabled). Complete one or more search fields. Please review the Scheduled Maintenance Please visit the Hurricane Preparedness page frequently to remain up-to-date with the latest information as it is made available. Use the, Verify your information matches what you submit on your claims. `]).vpF'~E/\YY6GK%p &JjcsJ>z$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 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. document for a comprehensive list of 2023 scheduled maintenance dates. Claim Status Request and Response | CMS 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. Florida ORI Numbers and Professions - Accurate Biometrics 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. 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 State Offices Responsible for State Exclusions and Program 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. 7:30 AM - 6 PM ET. Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older. Default Pay Multiple Service Locations, Performing 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. ROPA - azahcccs.gov 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. Fort Lauderdale, Florida. Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! Health plans can access the sample test files with the new layout on the Submission Information page of the Florida Medicaid Web Portal. Search Providers | Florida Department of Health Home Programs & Services Infant, Child & Adolescent Health CMS Managed Care Plan Search Providers Search Providers CMS Plan 850-245-4200 CMSPlan@flhealth.gov Mailing Address Office of the CMS Managed Care Plan 4052 Bald Cypress Way, Bin A06 Tallahassee, FL 32399 0000019453 00000 n %%EOF To enroll, you must have an NPI. 0000048537 00000 n (cont. Provider Directories | Florida Medicaid | Sunshine Health 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. 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 Need access to the UnitedHealthcare Provider Portal? ( Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. %PDF-1.6 % The benefit information provided is a brief summary, not a complete description of benefits. Master List of Durable Medical Equipment, Prosthetics, Orthotics - CMS 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. INVALID- PLEASE CHECK SPELLING, SPACING, ORDERING SERVICE ADDRESS IS INVALID- Agency for Health Care Administration - Florida <> lock You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. endobj Registered providers enrolled as provider type 97 MANAGED CARE TREATING PROVIDER - NON-MEDICAID. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. 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. 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- 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. Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. 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 Provider Master List - Florida NPI to Medicaid ID Search Engine: The existing tool has been enhanced and is accessible via the secure Web Portal. 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. YouTube page for Georgia Medicaid; How can we help? PDF Claim Issues Tip Sheet: Billing of Provider Data Elements-Taxonomy/PML Please contact the Public Records office for questions about the public records requests. . % This is done through the provision of quality services to meet the care needs of . Or start a search using ourFind A Providertool. 0000001572 00000 n 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. _b>? Preauthorization and Notification Lists for Healthcare Providers - Humana All Contacts. Claim submissions . 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. 0000063183 00000 n 0000022399 00000 n <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 29 0 R 30 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Providers and Agents. . In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. 1) and then clicking on Florida Medicaid Taxonomy Guide (you may be prompted to download the spreadsheet if it doesn't open automatically). Please note that a new browser window will open. 826 0 obj <>stream 0000015958 00000 n Medicaid & CHIP Enrollment Data. Have questions? 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. To become a Medicare provider and file Medicare claims, you must first enroll in the Medicare program. A new application must be submitted if the ATN was terminated before March 2022. Also, as delineated in the budget, if providers dont use the rate increase as intended, employees may bring civil action against the provider. Detail Default Pay Multiple Service Locations, Ordering For instructions, see ourFind A Provider Step-by-Step Guide (PDF). 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). This requirement also helps ensure we have the proper information needed to promptly pay your claims. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. PDF Provider Directory Data Quality - Texas PDF Exceptions Process - LIBERTY Dental Plan Official websites use .govA .gov Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. 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. from pg. AHCA Find Medicaid Doctors, Dentists, and Specialists - Florida hbbd```b``65 d3E`rX$LX$XDNL q%VV@&F`Jg-@ T X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . FL DOH MQA Search Portal | License Verification code to match the state Provider Master List (PML). endstream endobj startxref No records found. Default Pay Multiple Service Locations, Referring Call your provider advocate for more information. Florida Department of Health | Division of Medical Quality Assurance Search Services, To verify a Nurse Licensure Compact Multi-State RN or LPN License, access. For more information, or to submit questions related to the new layout, please email the Health Plan Support team at: healthplan.support@gainwelltechnologies.com. 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. 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). 0000063950 00000 n 0000026201 00000 n TIN - Tax ID Number . Download the free version of Adobe Reader. Please review the Known Issues and Informational Items List for details listed related to the MMIS. For more information contact the Managed Care Plan. Providers can access this information on the Enrollment Status page under the Provider Services tab. 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. Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . Revised CARC/RARC Combinations for Encounter Submissions, New and Enhanced Self-Service Features Now Available, Provider Master List and Pending Provider List Test Files - Now Available, Important Upcoming Policy Change: New and Enhanced Self-Service Features Available February 2022, Updated Provider Master List Tip Sheet Now Available, New Location Code (NLC) Wizard and National Provider Identifier (NPI) Crosswalk Enhancement Notifications, Referring, Ordering, Prescribing, and Attending (ROPA) Claims, 2023 Gainwell Technologies. AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. 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. 0000048276 00000 n Questions? Find Your Taxonomy Code | CMS - Centers for Medicare & Medicaid Services 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 ? YM}O}H-~u.:t `'m@#q# t3>:khAC^Qdb.KktxU#\^Xuv=5 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 0000000016 00000 n T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL Provider Services - Florida The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. %%EOF | D61, Referring, Ordering, Prescribing, and Attending Providers, Known Issues and Informational Items List, Holiday Office 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. 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Florida | Medicaid 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 Online Form. AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. 304 0 obj <>stream stream Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. Additional information can be found on the ROPA page, under the Agency Initiatives tab on the public Web Portal. Default Pay Multiple Service Locations, Other 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 Florida Medicaid - FLRules You must include the following information for billing and rendering providers when submitting claims: What you need to do 0000011307 00000 n (Use fewer fields to produce more results: See Search Help), Privacy Statement | For additional assistance, please contact Provider Enrollment at 1-800-289-7799, Option 4.