AHCA requirements 0000018945 00000 n Sunshine Health is a managed care plan with a Florida Medicaid contract. 0 (Use fewer fields to produce more results: See Search Help), Privacy Statement | X Providers HCBS Incident Reporting System Medicaid Pharmacy Preferred Drug Lists Provider Forms Provider Types Public Notices . 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. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. Closure document for a comprehensive list of 2023 scheduled holidays. Medicaid Fair Hearing; 0000001251 00000 n 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. x]moF a?J. "W%6TTofkG Community Care Plan - Home - ccpcares 786 0 obj <> endobj Default Pay Multiple Service Locations, Referring 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 0000022399 00000 n This enhanced wizard allows Individual providers (Entity Type 1) to add additional service location addresses to their existing files. Please note that a new browser window will open. Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. stream PLEASE CHECK SPELLING, SPACING. YouTube page for Georgia Medicaid; How can we help? Limitations, co-payments and restrictions may apply. The benefit information provided is a brief summary, not a complete description of benefits. ROPA - azahcccs.gov 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. AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. Florida Department of Health | Division of Medical Quality Assurance Search Services, To verify a Nurse Licensure Compact Multi-State RN or LPN License, access. *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! 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. PDF Provider Directory Data Quality - Texas AHCA will reopen ATNs for ALF providers who previously submitted an application that was terminated for incomplete documentation within the last six months. ( 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 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). The list of certified browsers can be found on the. Revised CMS-1500 Claim Form (front . Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . Call Us. % Please try your search again with other search values. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. Limitations, co-payments and restrictions may apply. 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. 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 Preauthorization and Notification Lists for Healthcare Providers - Humana 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? Throughout this initiative, the Agency and Gainwell will keep the provider and health plan communities apprised of changes as they occur via Agency e-Alert notifications. Default Pay Multiple Service Locations, Performing hbbd```b``65 d3E`rX$LX$XDNL q%VV@&F`Jg-@ T Megamenu requires javascript to be enabled in your browser. 0000025810 00000 n We recommend you use a certified browser to ensure that the application functions as expected. Some providers may not perform certain services based on religious or moral beliefs. 0000042555 00000 n The New Service Type or Address Request form will no longer be processed. You will need Adobe Reader to open PDFs on this site. %PDF-1.6 % The Enrollment Tracking Search feature has been updated to include application deficiency reasons. Medicaid Provider Enrollment Requirements Fact Sheet 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. This page contains important information for providing continued services to displaced Florida Medicaid recipients impacted by Hurricane Ian. Action Required: Please complete the application wizard with AHCA online to renew and/or complete your Medicaid ID registration. Or start a search using ourFind A Providertool. To distribute the funds appropriated for the Medicaid provider minimum wage requirement, AHCA has been directed to increase Medicaid managed care reimbursement rates and certain Medicaid fee-for-service fee schedules. ACCESSING PROVIDER MASTER LIST - PDF Free Download from pg. Early Intervention Services | Sunshine Health They are located on the AHCA public web portal under Provider Services/EDI/Companion guides. code to match the state Provider Master List (PML). 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. Agency for Health Care Administration - Florida . 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. endstream endobj 269 0 obj <. Example: ME99999 or ME069999. 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. INVALID, REFERRING SERVICE ADDRESS IS INVALID- Florida Medicaid - Sign In A new application must be submitted if the ATN was terminated before March 2022. Fort Lauderdale, Florida. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. 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. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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.

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