Florida Medicaid New Provider Enrollment

Date:

Enjoy A Gift Card From Us

Compliance Tips for Florida Medicaid Providers

MCNA rewards our members who take care of their oral health!

Parents or guardians of our Florida Medicaid Dental Health Program members can earn a $10 Amazon.com Gift Card* per child! To earn this reward, the child must see the dentist for an initial dental exam and preventive service when they join our plan. They must then go back for a follow-up dental checkup within 6 months. Adult members aged 18 and older can also earn this reward when they complete the steps listed above.

To learn more, call MCNA toll-free at 1-855-699-6262.

Required Documents For Those Applying For New Submitter Id’s

The following documents are required enrollment documents that must be completed, signed and returned to the FL Medicaid office prior to initiation of electronic claims submission or inquiry.

  • Scroll to the bottom and click on the EDI Data Interchange Agreement link

If you have any questions regarding any of the documents in this package, please call the EDI Technology Support Center at 1-866-586-0961.

We can now process 276/277 requests . If this is a transaction you would like to utilize please make sure to enroll with the payer.

  • Enter your Medicaid Provider ID and NPI

  • Enter your Business/Practice or Provider Name

  • Complete your demographic and contact information

  • If you are a provider using ClaimShuttle to bill your claims directly to Medicaid, choose Provider

  • If you are a Billing Service, choose Billing Agent/Clearinghouse

  • Note to Billing Services: Once you receive your ID from Medicaid, you must have each of the providers you are billing for also complete a copy of this form and state they are a “Provider”

Section 1

  • Providers using SolAce basic to bill directly can enter their current Trading Partner ID if they have one or leave this section blank

  • Providers using a billing service must choose the second option and enter the billing services assigned Trading Partner ID on the line.

  • For transactions sets please choose either 837I or 837P and 835

  • What Is The Difference Between Mi Bridges And Mi Enrolls

    MI Bridges is a system used to apply for state benefits. These are benefits like health coverage, cash assistance, food assistance and more. It is also the system used to update personal information.

    Michigan Enrolls is where you change Medicaid health plans. You can call MI Enrolls at 888-367-6557 to get help signing up for a Medicaid plan, ask questions or change plans.

    Still have questions? Contact your Medicaid health plan provider or MI Enrolls. You can also learn more through the Priority Health Medicaid learning center. Priority Health Medicaid members can learn more about their Medicaid benefits here.

    N4001-09 Approved MHC04042021

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    American Disabilities Act Notice

    In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

    Unitedhealthcare Senior Care Options Plan

    30,000 Florida Medicaid Enrollees At Risk Of Identity Fraud

    UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

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    History Of Floridas Medicaid Program

    Florida was one of the later states to implement a Medicaid, not adopting the program until January of 1970 .

    Florida Medicaid spending grew 13.5% on average every year between 1980 and 2004. In an effort to slow that trend, Florida applied for and received approval for an 1115 waiver for its Medicaid Reform pilot. The pilot implemented managed care in two counties in 2006 and added three more counties in 2007 the waiver was extended several times.

    In 2013, the federal government approved an amendment for statewide expansion of managed care the amendment also renamed Medicaid Reform as Managed Medical Assistance . Ninety percent of all Florida Medicaid beneficiaries are now enrolled in managed care plans, like health maintenance organizations . The state hopes to improve quality through better coordination of care and save money through smaller networks of providers.

    Part of the reason Medicaid enrollment has grown is the extensive outreach on the part of ACA navigators some residents were already eligible for Medicaid or CHIP prior to 2014 , but werent aware of their eligibility until enrollment outreach efforts under the ACA. But since Florida hasnt expanded Medicaid, the newly insured population is covered according to the normal state/federal split.

    Floridas decision not to expand Medicaid leaves nearly 400,000 people in the state in the coverage gap ineligible for Medicaid and also ineligible for tax subsidies to help them afford private health insurance .

    Before You Call The Florida Medicaid Phone Number

    As we mentioned above, the Florida Medicaid phone lines are flooded with phone calls as a result of the fact that their offices have been closed during the pandemic.

    Therefore, hold times are long when you call the phone number.

    We have answered the top questions people call the Florida Medicaid Phone Number for.

    Scroll down below to see if your question has been answered below.

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    Our Member Services Departmentcan Answer Your Questions

    Community Care Plan members enrolled in our Medicaid plan can contact our team for help with many services.

    If you are a Community Care Plan Medicaid member, please call us at for help with:

    • Finding a provider
    • Replacing a lost ID card
    • Planning care for the birth of a new baby
    • Explaining plan changes or benefit options
    • Answering general plan questions

    Community Care Plan values your care.If you have any concerns with your childrens Physical, Occupational or Speech Therapy Services, please call Yvie Noel at 622-3272.

    Unitedhealthcare Dual Complete Plans

    Eye on Oversight – Medicaid Provider Enrollment Screenings

    Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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    How do I become a Medicaid Provider?

    Who May Enroll In A Statewide Medicaid Managed Care

  • Voluntary Recipients:

    Some Medicaid recipients are not required to enroll in an MMA plan, but may choose to enroll if they meet all other enrollment requirements.

  • Mandatory Recipients:

    Some Medicaid recipients will receive directions that they must enroll in a plan:

  • Information will be provided regarding the plans available in their region
  • Name of the plan they are assigned to
  • The details about how to make a plan change
  • Also Check: What Is A Medicaid Provider Number

    How To Become A Medicaid Provider

    Providers delivering autism spectrum disorder services must be enrolled with SCDHHS as a Medicaid provider to deliver and bill for Medicaid state plan benefit ASD services.

    To enroll with SCDHHS as a Medicaid provider:

  • Prep for Enrollment: Providers will need a national provider identification and taxonomy number. Apply for individual National Provider Identifier number. Use the correct taxonomy code as listed in the provider manual.
  • Complete and submit the Medicaid provider enrollment application.
  • SCDHHS will notify providers of successful enrollment.
  • *Note, BCBA and BCaBA providers must enroll individually. If there is a group practice, a group enrollment must also be completed.

    To enroll with one of the managed care organizations , a provider must be an approved Medicaid provider. Providers need to contact the MCO directly to complete the network enrollment process. Providers are not required to enroll with a MCO, but they may not be reimbursed by the MCO for services provided to beneficiaries enrolled in managed care.

    To enroll with a MCO:

    • Contact each MCO to begin the process of contracting, credentialing and enrolling.
    • MCO contact information:

      Healthy Blue 757-8286

      First Choice by Select Health 741-6605

      Molina Health Care of South Carolina 237-6178

    P. O. Box 8206 Columbia, SC 29202-8206 | Email: | phone: 549-0820

    Language Services

    If your primary language is not English, language assistance services are available to you, free of charge. Call: 1-888-549-0820 .

    Providers > waiver Provider Enrollment

    SMMC Long

    Becoming a Provider is a Free Process

    *All APD Provider Enrollment documents may be found in the document portion of the website HERE

    EFFECTIVE IMMEDITELY: Pursuant to the iBudget Waiver program, authorized under 1915 of the Social Security Act, and because of critical needs for some specific provider types, APD will no longer operate two open enrollment periods each year for provider applicants of services furnished under the iBudget waiver. Effective immediately, Regional offices will accept provider applications at all times.

    Although APD will accept provider applications at all times, please keep in mind that certain critical needs exist for specific provider types in each APD Region. Each Region will identify critical service needs on the APD Provider Enrollment website. Please check Regional websites for more information at:

    Due to the current COVID-19 outbreak, most APD employees are teleworking. To avoid delay in processing provider applications, please email applications to the Provider Enrollment mailbox for the Region where you are applying to render services as follows:

    Steps for Applying as an APD iBudget Waiver Provider

  • Applicants who do not currently have an APD General line item eligibility determination in the AHCA Background Screening Clearinghouse will submit an APD Letter of Intent to their APD regional intent email inboxes. for the Letter of Intent and e-mail instructions.
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    How Do I Change Plans

    Are you interested in becoming a Louisiana Healthcare Connections member? Here are answers to some of the common questions you might have about how to switch your Healthy Louisiana Medicaid plan.

    I was recently approved for Medicaid, but I want to change my plan. How do I switch?

    To change health plans by phone, call Healthy Louisiana at 1-855-229-6848 . Remember: free interpretation services are available to you if you need them.

    To change plans online, . This will take you to the Healthy Louisiana secure login page. Youll be asked to enter some basic information to get started.

    You can also use the Healthy Louisiana app to change plans. You can download the Healthy Louisiana app in the Apple App Store or .

    I want to switch plans, but Im not a new Medicaid member. Can I do that?

    You can change your Healthy Louisiana plan after the first 90 days for certain reasons. These reasons might be that your plan changed the services you need, or you cant get the kind of care you need.

    You can only change plans by phone after the first 90 days. Youll need to call Healthy Louisiana at 1-855-229-6848 and ask for a transfer form.

    I was told I can change plans during Open Enrollment. What is that?

    Open Enrollment is a period of time held every year when you can switch plans. Youll get a letter in the mail letting you know when Open Enrollment will be. The letter will also tell you how to switch health plans. If you dont want to switch plans, you wont need to do anything.

    Not Sure If You Are A Member

    If you are approved for Medicaid and not sure if you are a Community Care Plan member, you can speak with a choice counselor to find out which care plan you are enrolled in. If you have not picked a health plan for your pregnancy, you may have already been placed into a health plan.

    If you have questions about your managed care plan, call the Choice Counseling Helpline toll-free at, TDD: , Monday through Thursday, 8 a.m.-8 p.m. Friday, 8 a.m.-7 p.m.

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    Provider Eligibility And Compliance

    Responsible for ensuring the continued eligibility of enrolled providers through research and validation of providers who are excluded from participation in Medicare, Medicaid, or other federally-funded programs documenting justifications for exclusions from Florida Medicaid coordinating with Medicaid Program Integrity and the OGC regarding referrals for legal sanctions monitor provider background screening processes taking appropriate actions when providers have disqualifying offenses participate on the Clearinghouse Advisory Board coordinate with Medicare related to mismatches in provider data between PECOS and the MMIS coordinate requests for onsite reviews with the RPA Onsite Review Desk perform change of ownership reviews, including determining if there is any pending enforcement action by MPI or MFCU, verify accuracy of ownership disclosures, and identify any money owed by the seller or the buyer and participate in an interagency workgroup on provider license compliance.

    Using Mychart Your Member Portal

    Enrolling in the Florida Medicaid Behavior Analysis Program

    As a Community Care Plan member, you have access to MyChart, our member portal. This is a secure self-service online portal where members can get personalized information about benefits and services. You can also communicate with our Member Services team.

    After you sign up, you can sign into the online portal with your confidential username and password. Once you sign into the member portal, you can:

    • Order an ID card
    • Make or change appointments

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    Medicaid Provider Enrollment Portal Frequently Asked Questions

    Will current providers be grandfathered in under the first cycle or will all current network providers have to re-enroll?

    No, current providers will not be grandfathered in under the first cycle of provider enrollment. Previously, managed care providers have not been required to enroll directly with Louisiana Medicaid through the fiscal intermediary. They have only completed the Medicaid enrollment process with a managed care organization . The new enrollment and screening process will be managed for all providers through the new web-based portal. This will bring the state into compliance with current federal requirements. All current providers, network and out-of-network, must complete the states enrollment process for claims to be approved by fee-for-service Medicaid and/or any of the MCOs.

    What address on file with Medicaid is the invitation going to?

    For providers enrolled with an MCO, Gainwell Technologies will send the invitation to the mailing address that is on file with the MCO. For providers only enrolled in fee-for-service Medicaid and not with any of the MCOs, Gainwell Technologies will send the invitations to the service location address which they have on file.

    If a provider needs to update their contact information, use the guidance below to determine how best to update their information.

    Will providers have individual logins for the Louisiana Medicaid Provider Enrollment Portal? Can providers revalidate by group?

    Will the portal use electronic signatures?

    What Information Do I Need

    • Name, date of birth, Social Security Number, and home address of each person with ownership or control interest in the provider.
    • Name, Federal Employer Identification Number, and applicable addresses for each entity with ownership or control interest in the provider
    • Internal Revenue Service document showing the provider’s name and tax identification number
    • Professional or facility license number, as appropriate.
    • National Provider Identifier from the National Plan and Provider Enumeration System , as appropriate.
    • Documentation of any adverse actions involving:
    • Criminal History,
    • Disciplinary action against any license,
    • Denial, termination, exclusion, suspended payments, or unpaid fines from Medicare or Medicaid in this or any state.
  • Required elements:
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    Enroll As A Member Of Mcna Dental

    If you live in Florida, you or your children may qualify for Medicaid dental care! The State of Florida will let you know that you have been assigned to one of three insurance companies to manage your dental needs.

    If you are assigned to MCNA Dental, you are in luck! You will automatically have access to great dental care and and services. You will also be eligible to get an Amazon.com Gift Card after two preventive dental visits.

    Do you need help choosing or changing dental plans? Medicaid has specially trained people to answer your questions and to help you enroll in the plan that best fits your needs. These people are called choice counselors and they provide services free of charge. To speak with a choice counselor, call the Statewide Medicaid Managed Care Help Line toll free at 1-877-711-3662 or visit www.flmedicaidmanagedcare.com.

    Please call our Florida Member Hotline at 1-855-699-6262 if you have any questions.

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