Florida Medicaid Provider List 2020

Date:

Unitedhealthcare Senior Care Options Plan

Humana Florida Medicaid 2020 in Review

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.

Where Can I Find A Doctor That Accepts Medicare And Medicaid

To find a doctor that accepts Medicare payments, you may want to visit the Centers for Medicare and Medicaid Services’ Physician Compare. You can search by entering a health care professionals last name or group practice name, a medical specialty, a medical condition, a body part, or an organ system. This tool will provide you with a list of professionals or group practices in the specialty and geographic area you specify, along with detailed profiles, maps and driving directions.

Please note that Physician Compare only lists professionals that accept Medicare. Although some may also accept Medicaid, it does not have information about which professionals do accept Medicaid.

Medicaid programs vary by state and each state Medicaid agency maintains their own list of professionals that accept Medicaid. For further assistance, please contact your health plan or state Medicaid agency. For more information about Medicaid, visit the Medicaid & CHIP page on Healthcare.gov.

If you have trouble accessing the Physician Compare website, please call 1-800-MEDICARE and a representative will be able to run the search for you. They can also send you a print version of the search results.

There are other directories on MedlinePlus that will help you find health professionals, services, and facilities, some of which may serve Medicare or Medicaid payments.

Unitedhealthcare Community Plan Medicaid Lookup Tools

Search for a Provider

Choosing a Plan to Search for a Provider

From the drop down list choose the Plan name that matches the name in the lower right corner of your UnitedHealthcare ID Card:

M*Plus – MMA Medicaid Benefits Only with UnitedHealthcare

Health & Home Connection – Long Term Care Benefits Only with UnitedHealthcare

M*Plus Connection – Both MMA and LTC Benefits with UnitedHealthcare

  • Please note: M*Plus Connection Members can search for Medicaid providers by choosing M*Plus and for LTC providers by choosing Health & Home Connection when doing a provider search.
  • PDF 104.15KB – Last Updated: 11/12/2020

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Mpip Year : Qualified Providers

Below is a list of Primary Care Physicians and OB/GYNs by name, reported by the plans to the Agency, who meet MPIP Year 5 qualifying criteria prior to the implementation date. All specialist physicians serving members under the age of 21 qualify for the MPIP program and will not be listed on the Qualified Providers list. Specialists are encouraged to work with their respective health plans to submit claims for the MPIP enhanced rates when providing services to members under the age of 21. Qualified providers will begin to receive enhanced rates for dates of service beginning on or after the implementation date.

During each year of MPIP, plans are required to reassess physician eligibility for the program six months after implementation. For MPIP Year 5, plans will be required to reassess physician eligibility for enhanced rates for dates of service beginning on or after April 1, 2021. This allows providers who become qualified after the October 1, 2020 implementation date a second opportunity to become eligible for MPIP. The Year 5 qualified provider list, available at the link below, will be updated after each reassessment.

MPIP Year 5 Qualified Providers List: October 1, 2020- September 30, 2021

If you are a provider contracted with a health plan to provide services and you feel that your name was omitted from the Qualified Providers List in error, please contact the plan directly. Plan contact information for providers can be found at the link below.

Prior Authorization And Notification Resources

Florida Medicaid Coronavirus/COVID

Find Local COVID-19 Diagnostic Testing Locations

Use these online tools to help find your patients find a COVID-19 diagnostic testing location:

Behavioral Health Providers

Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health.

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

The state-specific requirements and process on how to join the UnitedHealthcare Community Plan network is found in the UnitedHealthcare Community Plan Care Provider Manuals.

The Centers for Medicare & Medicaid Services established the Medicaid Managed Care Rule to:

  • Promote quality of care
  • Strengthen efforts to reform the delivery of care to individuals covered under Medicaid and Childrens Health Insurance Plans
  • Strengthen program integrity by improving accountability and transparency

Enhance policies related to program integrity With the Medicaid Managed Care Rule, CMS updated the type of information managed care organizations are required to include in their care provider directories.

Visit UHCCommunityPlan.com/FL for current plan names, overview of eligibility information, doctor look up and more.

Member Health Waivers

If you are a provider of a member whose health was previously cared for under one of the following waivers, please contact Provider Services for extra help understanding your full benefit program:

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Supporting You In An Emergency Or Disaster

We are here to support you during public health emergencies or disasters. We partner with organizations and agencies in Florida to make sure our members have the resources they need, from access to healthy food to in-person and phone support from care coaches.

See what steps we take to make sure you are covered.

I Would Like To Change My Health Or Dental Plan

Change Health or Dental Plans Online

Log in to the FL Medicaid Member Portal to change your Health or Dental Plan. We will walk you through the process of changing your plan.

Why should you sign up for a FL Medicaid Member Portal account?

  • You can check your Medicaid eligibility and enrollment status
  • View and update your address
  • Request help using secure messaging
  • Enroll in a plan or change plans
  • File complaint and see what is happening with your complaint
  • Go paperless. Choose to only get letters from Medicaid electronically
  • Receive email or text message alerts

Other Ways to Change Your Health or Dental Plan

If you are unable to change Health or Dental Plans online at this time, there are several other options available to you.

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Covid 19 Test Kit Reimbursement Request Form

  • PDF 67.59KB – Last Updated: 07/11/2022

Direct Member Reimbursement

If you receive a drug at an out-of-network pharmacy, the out-of-network pharmacy will not have the needed information to bill your drug to us. Under certain circumstances, such as an out-of-area emergency, you may be reimbursed for your medication. You will need to pay for the drug and then complete a Direct Member Reimbursement form to be reimbursed for the cost of the drug.

  • PDF 97.41KB – Last Updated: 11/12/2020

Unitedhealthcare Connected For Mycare Ohio

PECOS Enrollment Tutorial Initial Enrollment for an Individual Provider

UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays, and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

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Update To Health Care Clinic Licensure For Florida Medicaid Providers

Monday, October 5, 2020

The following is an update from the State of Florida Agency for Health Care Administration:

During the 2020 Florida legislative session, an exemption to health care clinic licensure for Florida Medicaid providers was added to Section 400.9905, Florida Statutes. As a result of this legislative change, Florida Medicaid providers are not required to seek health care clinic licensure. Effective July 1, 2020, Florida Medicaid does not require any provider to show proof of licensure as a health care clinic nor proof of exemption from licensure as a health care clinic. Current, reenrolling, or new Florida Medicaid providers do not need to show proof of licensure as a health care clinic nor proof of exemption from licensure as a health care clinic. Florida Medicaid is working to update the Enrollment Policy to remove these requirements to align with Section 400.9905, Florida Statutes for all of the below providers:

Why Is It Important For Me To Go To The Dentist

Preventive dental services are covered benefits. MCNA encourages you to schedule an appointment with your dentist. Regular preventive dental checkups are very important. They can prevent serious dental conditions from happening. If you would like help scheduling an appointment, please call our Member Hotline at 1-855-699-6262. It is open Monday through Friday, from 8 a.m. to 8 p.m.

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Unitedhealthcare Connected General Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

American Disabilities Act Notice

Medicaid Provider Enrollment Fingerprinting

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.

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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.

Unitedhealthcare Dual Complete Plans

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.

Recommended Reading: What Does My Medicaid Cover

Find A Dentist Near You

MCNA has a large network of general and specialty dentists throughout Florida. You can choose a dentist from MCNAs online Provider Directory. The directory is always current.

Please call our Member Hotline at 1-855-699-6262 if you need help to find a dentist. We can also help you schedule an appointment for dental care. to download a Provider Directory for your region.

Enjoy A Gift Card From Us

Florida Medicaid HCBS | Navigating the Program

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.

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How Much Do I Have To Pay For Dental Services

The Florida Medicaid Dental Health Program covers many of the costs of routine dental care. You qualify based on your familys income. Families with children or adults who receive Medicaid services have no co-payments. You may have a $3 copayment per day for a nonemergency dental visit in a federally qualified health center.

If your dentist orders a prescription drug for you, we can help you get that drug through Medicaid or your Medicaid health plan. You can avoid extra costs by checking that your drugs are on the Agency for Health Care Administrations Preferred Drug List.

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