How to contact Provider Services at Florida Medicaid?
1800-289-7799
How do providers check Florida Medicaid eligibility?
Provider Support provides research and technical support for Medicaid Fee-For-Service claims inquiries and processing issue resolution. For assistance contact 1-877-254-1055.
How often should providers verify a patient's Medicaid eligibility?
Providers are responsible for verifying eligibility every time a member is seen in the office. PCPs should also verify that a member is assigned to them. Eligibility can be verified through the Recipient Eligibility Verification System (REVS).
Who handles Medicaid in Florida?
Medicaid services in Florida are administered by the Agency for Health Care Administration. Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients).
How do I contact the AHCA in Florida?
To file a health care facility complaint, call (888) 419-3456 / (800) 955-8771 Florida Relay Service (TDD number) or complete the Health Care Facility Complaint Form.
How to submit an Appeal
Upload a Medicaid Fl Exceptional Claims Form via the Florida Medicaid Web Portal.
Contact Medicaid FL Provider Services and create a "Ticket" to request Provider Rep assistance.
How to contact my dedicated Provider Rep
Call Provider Services at 1800-289-7799
Create a "Ticket" for a Provider Rep Callback
What does Medicaid Fl Family Planning cover?
Medicaid reimburses for family planning waiver services to eligible women for a maximum of 24 months including: Family planning initial or annual examinations. Family planning counseling visits. Family planning supply visits. Human immunodeficiency virus (HIV) counseling visits.
How to get a Prior Authorization for an Inpatient services?
The Agency for Health Care Administration has contracted with a certified Quality Improvement Organization (QIO), eQHealth Solutions, Inc. to provide medical necessity reviews for Medicaid home health services. For more information on eQHealth Solutions, Inc. please visit the website.
Medicaid Provider Portal (FLMMIS)
FLMMIS is the Florida Medicaid Management Information System's secure web portal, which provides self-service tools and communication for providers. Users can access applications, manage accounts, and change passwords through the portal. The portal also offers training presentations and web-based resources for providers.
The Florida Agency for Health Care Administration (AHCA) manages Medicaid services in Florida, and Gainwell Technologies provides training for the FLMMIS. For assistance with the portal, users can refer to the Secure Web Portal Maintenance Quick Reference Guide or visit the Contact Us page
How to obtain a NPI number in Florida?
If you have a social security number and do not have a NPI, go to https://nppes.cms.hhs.gov, complete the application and submit.
Fl Medicaid Provider Enrollment Policy
https://ahca.myflorida.com/content/download/5923/file/59G-1.060_Enrollment.pdf
What is Limited to Family Planning Coverage?
Florida Medicaid's Family Planning Waiver Program, also known as "Family Planning Medicaid for Today's Woman", limits coverage to certain services. The program is available to women who have not had a hysterectomy or sterilization and have a household income at or below 185% of the federal poverty level. The program covers the following services:
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Physical exams, including a pap smear, breast exam, and STD testing
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Family planning counseling and pregnancy testing
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Birth control supplies, including condoms
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Evaluation and treatment for STDs
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Approved sterilization
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Colposcopies
The program does not cover emergency room visits, inpatient services, or any other non-family planning related services. Medicaid reimburses for these services for up to 24 months. For more information, you can call 1-877-254-1055.
What is SLMB?
The Specified Low-Income Medicare Beneficiary (SLMB) Program is a Medicare Savings Program (MSP) that helps people with limited income and resources pay for some or all of their Medicare premiums. The program is administered by each state's Medicaid program and helps pay for Medicare Part B premiums.
To qualify for SLMB benefits, you must meet certain income and resource limits, which change from year to year. For example, in 2024, the limits are:
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Individual monthly income limit: $1,526
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Married couple monthly limit: $2,064
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Individual resource limit: $9,430
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Married couple resource limit: $14,130
You can check the Medicare Savings Programs page for the most up-to-date income requirements. You can also contact your state's Medicaid office to find out the current limits if you live in Alaska or Hawaii, where income limits are slightly higher.
You can apply for SLMB benefits by calling your state Medicaid Program, 1-800-MEDICARE (1-800-633-4227), or TTY users can call 1-877-486-2048.
What is QMB?
QMB, or Qualified Medicare Beneficiary, is a program that helps low-income people who are eligible for Medicare pay for some or all of their Medicare costs. QMB is part of Medicaid, but it's not the full program. QMB can help pay for: Part A and Part B premiums, Deductibles, Coinsurance, and Copays for Medicare-covered items and services.
QMB beneficiaries don't have to pay for these costs, and federal law prevents Medicare providers from billing them. For example, QMB can help reduce the cost of insulin from $300 per month to $4.15 per month when someone is in the "Donut Hole". QMB can also pay back a portion of the standard Medicare Part B premium into a beneficiary's Social Security check each month.
To qualify for QMB, a person must meet certain income and resource limits. For example, in Colorado, an individual must have a monthly income of $1,235 or less, and a married couple must have a monthly income of $1,663 or less. A single person can have resources of up to $10,930, and a married couple can have resources of up to $17,130. However, the first $20 of a person's monthly income is usually not counted toward the limit, and any Supplemental Nutrition Assistance Program (SNAP) benefits are also excluded.
Eligibility for QMB usually begins on the first day of the month after the Medicaid agency has all the necessary information and verification. This process shouldn't take more than 45 days.
What is "ML: A" plan coverage
ML A is a Medicaid program code in Florida that stands for AFDC-Related Emergency Medical Assistance for Noncitizens. It's limited to emergency care, such as labor and delivery, kidney dialysis, and emergency inpatient care. Noncitizens who are eligible for Medicaid, but not for citizenship, may be eligible for this program to cover serious medical emergencies. However, tourists and people in Florida for business are not eligible. Applications for ML A can be made at the Department of Children and Families (DCF), and more information can be found on the DCF website or by calling (866) 762-2237.
What is the medically needy program in Florida?
The Medically Needy Program assists individuals who would qualify for Medicaid except for having income that is too high. Individuals enrolled in Medically Needy may have a monthly “share of cost”, which is similar to an insurance deductible. The share of cost is determined by household size and gross monthly income.
Does Florida Medicaid pay caregivers?
As of 5/5/24, Florida Medicaid pays caregivers a wage for their services and provides additional benefits such as health insurance and paid time off. To apply for the program, the recipient must meet the eligibility criteria and complete an application with their local Area Agency on Aging.
Florida Medicaid Long-Term Care Definition
Medicaid is a health care program for low-income individuals of any age. While there are various coverage groups, this page is focused on long-term care Medicaid eligibility for Florida senior residents (aged 65 and over). In addition to care services in nursing homes, adult family care homes (adult foster care homes), and assisted living facilities, FL Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which FL seniors may be eligible.
What Defines Long Term Care? Types of Care included
The term, “long-term care”, sometimes abbreviated as LTC, can be quite vague, and many people are uncertain as to exactly what this means. To begin, there are specific activities that one must do on a daily basis to take care of oneself. These activities are bathing, dressing, grooming, using the toilet, mobility (the ability to move about), transferring (i.e., moving from a bed to a wheelchair), and eating. These activities are commonly called Activities of Daily Living (ADLs). If one cannot complete these activities without assistance, they are unable to live independently. In very simple terms, long-term care is assistance for persons who can no longer perform these basic day-to-day activities on their own. Relevant to the elderly, the need for care can be due to the natural process of aging, a sickness, or the progression of Alzheimer’s, Parkinson’s disease, or another type of dementia.
Medicaid, a federal and state health care program for financially needy persons, offers a further definition of LTC. Medicaid defines it as assistance for persons who have chronic, ongoing illnesses or disabilities, and because of these conditions, care equivalent to that which is provided in a nursing home is required. “Nursing Facility Level of Care” is not federally defined, and each state is left to define what it means for its state and long-term care Medicaid programs. Therefore, the criteria for this level of care is not consistent across states. Furthermore, many states now offer personal care assistance via their Regular State Plan Medicaid program, which via most pathways, allows for a more lenient care requirement.
In addition to non-medical care, long-term care also assists persons with health related issues. However, for the most part, long-term care is non-medical in nature. The variety of services and care assistance that make up long-term care, and the settings in which it can be provided, is quite large.
What Defines Long Term Care? Types of Care included
(1) Each provider agreement shall require the provider to comply fully with all state and federal laws pertaining to the Medicaid program, as well as all federal, state, and local laws pertaining to licensure, if required, and the practice of any of the healing arts, and shall require the provider to provide services
How much is the Medicaid provider enrollment fee in Florida?
This notice announces a $631.00 calendar year (CY) 2022 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new Medicare practice location.
Telehealth laws and services in Florida
Whether you are a provider or a patient, anything you need to know about telehealth laws and services in Florida can be found on this official government website. One can verify a license, sign up for updates, access registration documents, and get answers to frequently asked questions on this resource.
Federal No Surprises Act
Florida law, along with the federal No Surprises Act, protects patients from surprise medical bills. These laws apply to emergency situations and when patients receive non-emergency services at in-network hospitals from out-of-network providers.
Reference-based pricing (RBP)
Reference-based pricing (RBP) is a health plan strategy that uses a specific reference point to determine reimbursement rates for medical services, instead of the provider's billed charge. With RBP, employers set a maximum amount they'll cover for a procedure, and providers must accept the RBP payment or justify why their fees are higher. The reference point is usually Medicare rates, or a percentage above those rates, that the payer considers reasonable. RBP can be used to replace or supplement a health plan's traditional "usual and customary" pricing for non-contracted claims.
Emergency Medical Treatment and Labor Act (EMTALA)
All hospitals are federally required under the Emergency Medical Treatment and Labor Act (EMTALA) to provide emergency care to any individual that seeks care in a hospital emergency department, regardless of their ability to pay.
Does Medicaid of Florida accept paper claims?
No, Medicaid of Florida does not accept paper claims.
How to refund Fl Medicaid
Void your paid ICN from FLMMIS. This will create a 59ICN# prompting Medicaid to recoup the payment.
How to contact the Florida Third Party Liability (TPL Unit)
1877-357-3268 or email FLTPR@hms.com
How to confirm patient eligibility for a DOS greater than 12 months from the current date
Call AHCA at 1877-254-1055, option 3, then option 1
How to file a complaint to AHCA
Click here then select the form that best describes you. AHCA complaint FAQs.
Department of Children and Families (DCF)
1(850) 300-4323 Fax 1(866) 619-5720
What is a Medicaid Crossover?
A Medicaid claim with traditional Medicare as the primary insurance
What is the filing limit for a Medicaid Crossover claim?
3 years from the date of service DOS