0000063432 00000 n %%EOF PDF NPI crosswalk logic change updates - Simply Healthcare Plans AHCA requires that every provider who participates with Medicaid or CHIP beneficiaries maintain an active status on their Medicaid ID. 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. For more information contact the Managed Care Plan. 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. 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. 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. All rights reserved. Date: hb```e``@(2K.D8pA5agE7KU1xt40[ q(K a`di)>LL3a<2^-pcIr|n0\a:MH330;X]?H3Q1@ G/ 2 Default Pay Multiple Service Locations, Facility NPI - National Provider Identifier. 49 37 Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. Email Us. The type and amount of services depends on the age of the beneficiary, the type of Medicaid program in which the beneficiary is enrolled, and the type of services determined medically necessary by the beneficiary's Primary Care Provider. HWn]E8?p3==/),0@fX 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 Detail Default Pay Multiple Service Locations, Ordering TIN - Tax ID Number . Default Pay Multiple Service Locations, Performing endstream endobj startxref (cont. means youve safely connected to the .gov website. 0000026034 00000 n 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. 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 If you would like to search for a complete list of licensed providers, please visit our data portal. Beginning October 8, 2021, a new self-service feature, the New Location Code (NLC) Wizard, will be available to eligible providers in the Florida Medicaid Secure Web Portal. Share sensitive information only on official, secure websites. 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. 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 4 0 obj 826 0 obj <>stream 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 Agency for Health Care Administration - Florida A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. PML - Provider Master List. Have questions? Providers and suppliers dont need to take action unless an item on the Master List also appears on one or both Required Lists: The Required Lists Comparison Chart (PDF) is a side-by-side crosswalk of both Required Lists. Address Maintenance Wizard: The current Change of Address (COA) Wizard has been renamed to the Address Maintenance Wizard. The New Service Type or Address Request form will no longer be processed. Disclaimer | 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. 0000041273 00000 n Secure .gov websites use HTTPSA To enroll, you must have an NPI. Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. 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). Password Resets. 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. An official website of the United States government code to match the state Provider Master List (PML). Provider, ROPA Taxonomy Is Missing Dtl Ordering 0000019903 00000 n We update the Code List to conform to the most recent publications of CPT and HCPCS . Florida | Medicaid Complete Enrollment for Your Medicaid ID | Sunshine Health All Contacts. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. 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. 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. Need access to the UnitedHealthcare Provider Portal? You will need Adobe Reader to open PDFs on this site. Providers and health plans are encouraged to review the tip sheet to understand how the enhancement will affect their claims and/or encounter submissions. 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). 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 2 0 obj Community Care Plan - Home - ccpcares The agency will be posting related updates to X12 837 companion guides soon. Sunshine Health is a managed care plan with a Florida Medicaid contract. Claims and encounters passed whenever a one-to-one match was found. COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS. https:// PDF Claim Issues Tip Sheet: Billing of Provider Data Elements-Taxonomy/PML 0 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 Claim Status Request and Response | CMS To access the tool, login to the secure Web Portal by clicking the Secure Web Portal Login button above. 0000000016 00000 n Provider Links - Florida AHCA maintains a Provider Master List (PML) on their Managed Care site ( for providers and MCOs to download and view. E I IW42@ Va~(i&^ L ,d(SJ{K"K7(52jT^FT,48P$1XT4k8e. T(z2Vxv2m.4.7\m^n\mo!zN??^rK5J~(^zL FL DOH MQA Search Portal | License Verification Healthcare Provider Resource Guide Statewide (Regions 1 - Humana 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. PDF FL Medicaid Reference Guide By using this site, you agree to the | Illinois Fingerprint Vendor Agency (license # 262.000016) The Sunshine Healthprovider directory is a list of physicians, hospitals and other healthcare providers that are available to you. Health plans will be able to access the revised report layouts on the Registration page of the Florida Medicaid Web Portal. Use the, Verify your information matches what you submit on your claims. Managed Care Plan with a Florida Medicaid contract. Box 5197, MS 62 Tallahassee, FL 32314; Report Medicaid Fraud . 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. % Transactions submitted with a From Date of Service of March 1, 2022, or later must use a valid taxonomy associated with the providers specialty. 0000011496 00000 n 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. 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. 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. Please review the Scheduled Maintenance document for a comprehensive list of 2023 scheduled maintenance dates. Sunshine Health has the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life. Complete one or more search fields. Toll Free: (877) 423-4746. 0000001251 00000 n Or start a search using ourFind A Providertool. Florida ORI Numbers and Professions - Accurate Biometrics Additional information on the status of your Florida Medicaid enrollment application is now available through self-service on the public Web Portal. 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. Florida State Medicaid Managed Care - Tab Window Title Registration | Florida Medicaid Web Portal 0000048907 00000 n 268 0 obj <> endobj AHCA - Agency for Health Care Administration. Additional information can be found in the NLC Quick Reference Guide (QRG), located in the Add Additional Locations section of the Enrollment Forms page. Transactions submitted with a From Date of Service of February 28, 2022, or earlier should use the taxonomy associated with the NPI Crosswalk. %PDF-1.6 % 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. 805 0 obj <>/Filter/FlateDecode/ID[<08E51282E405684D9C17F1CE6F8C1661><5571271B0099974DBF27615CD82AD9C9>]/Index[786 41]/Info 785 0 R/Length 100/Prev 808182/Root 787 0 R/Size 827/Type/XRef/W[1 3 1]>>stream 0 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. Please visit the Hurricane Preparedness page on the public Web Portal under the Agency Initiatives tab. Early Intervention Services | Sunshine Health Megamenu requires javascript to be enabled in your browser. 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. 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. website belongs to an official government organization in the United States. 0000001572 00000 n 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 To become a Medicare provider and file Medicare claims, you must first enroll in the Medicare program. + 7B You may also search for CMS providers in your area by selecting the regional provider directory for your county from the table below. Limitations, co-payments and restrictions may apply. For more information contact the Managed Care Plan. Florida State Medicaid Managed Care - Home Page [q@R[Chu$%ZYy+zYY-R4ihlrQu-nKdq:T,dhMq)u"8,RG6~]YBgFAsA OAzcV!"bJHJ. Call your provider advocate for more information. Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan: Resubmitting denied claims Providers will see multiple changes to the Web Portal over the next few months regarding NPI Crosswalk. Providers participating in a Florida Medicaid managed care plan are federally required to enroll in Florida Medicaid. October 8, 2021, a new self . lock Accessibility, document.write(new Date().getFullYear()) FL HealthSource, All Rights Reserved 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.