October 8, 2021, a new self . 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 0000018945 00000 n Florida ORI Numbers and Professions - Accurate Biometrics 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. Sign up to get the latest information about your choice of CMS topics. Fort Lauderdale, Florida. 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). This requirement also helps ensure we have the proper information needed to promptly pay your claims. 49 0 obj <> endobj xref Healthcare Provider Resource Guide Statewide (Regions 1 - Humana Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. 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. Providers who fail to sign the agreement will be subject to audits and recoupment of funds associated with the minimum wage requirement. PLEASE CHECK SPELLING, SPACING, REFERRING DETAIL SERVICE ADDRESS IS Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims Complete Enrollment for Your Medicaid ID. 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. To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. 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 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). 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." Provider Enrollment - Florida Florida Medicaid: Claim and AHCA data must match + 7B PDF NPI crosswalk logic change updates - Simply Healthcare Plans Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. 0000019074 00000 n . Florida Medicaid - Sign In 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 0000048537 00000 n Megamenu requires javascript to be enabled in your browser. 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. Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older. 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 AHCA requirements 0000001572 00000 n 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. 268 0 obj <> endobj NPI Directory State of Florida - NPI Profile Default Pay Multiple Service Locations, Referring If you dont take action by your PML expiration date, you will be terminated from the Sunshine Health network on your PML expiration date. Disclaimer | Florida | Medicaid Privacy Policy. . Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. The Recipient Procedure Lookup is available from the Claims menu or the Eligibility menu. Florida State Medicaid Managed Care - Health - Health Plans and Program 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- NPI - National Provider Identifier. Example: ME99999 or ME069999. Claim submissions . (cont. *@ ?&ny`mk(>sUM'A{808+D5RtJ)NK'KL.pn& E|mH.kvzYE.=,-2u-Gpf! Home | Florida Medicaid Web Portal Please contact the Public Records office for questions about the public records requests. Download the free version of Adobe Reader. This enhancement replaces the New Service Type or Address Request form that is currently used to request a secondary location. Sunshine Health is a managed care plan with a Florida Medicaid contract. Default Pay Multiple Service Locations, Referring 304 0 obj <>stream 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. Claim Status Request and Response | CMS All rights reserved. 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. 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. 0000014536 00000 n Early Intervention Services | Sunshine Health 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. Claims with a From Date of Service of February 28, 2022, the ZIP+4 from the NPI Crosswalk should be used. Provider Directories | Florida Medicaid | Sunshine Health 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. Limitations, co-payments and restrictions may apply. 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. 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. %PDF-1.7 We can help. Registered providers enrolled as provider type 97 MANAGED CARE TREATING PROVIDER - NON-MEDICAID. 0000017333 00000 n . stream In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. 2 Default Pay Multiple Service Locations, Facility 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. 0000041273 00000 n HWn]E8?p3==/),0@fX 0000026034 00000 n 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. 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). AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. endobj r>LFoc6rw,0-ccIp3@IqusJ. 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. Download the free version of Adobe Reader. %PDF-1.4 % The agency will be posting related updates to X12 837 companion guides soon. The New Service Type or Address Request form will no longer be processed. INVALID, REFERRING 2 ZIP CODE IS MISSING/ Master List of Durable Medical Equipment, Prosthetics, Orthotics - CMS JavaScript required - Sign In | r]G(c>|2]eVg\PP 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. 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. 0000001251 00000 n Provider, ROPA Taxonomy Is Missing Dtl Ordering Florida State Medicaid Managed Care - Tab Window Title Preauthorization and Notification Lists for Healthcare Providers - Humana endstream endobj 269 0 obj <. You will need Adobe Reader to open PDFs on this site. Call your provider advocate for more information. The Agency is also required to enter into a supplemental wage agreement with each impacted Medicaid Provider by October 1, 2022, to ensure compliance with the minimum wage requirements. We update the Code List to conform to the most recent publications of CPT and HCPCS . hbbbd`b``* / endstream endobj 50 0 obj <>/Metadata 3 0 R/Pages 2 0 R/StructTreeRoot 5 0 R/Type/Catalog/ViewerPreferences<>>> endobj 51 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 0.0 -396.0]>>/PageUIDList<0 211>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 52 0 obj [/Separation/PANTONE#20Blue#20072#20CVC#201/DeviceCMYK<>] endobj 53 0 obj <>stream
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