Under the smmc program, most medicaid recipients are enrolled in a health plan. In 2014, the florida medicaid program implemented a new system through which medicaid enrollees receive services. Medicaid will rep esent approximately 33% of the entire state budget in sfy 201112. In florida, the agency for health care administration agency is responsible for medicaid. Statewide managed medical assistance program medicaid.
Welcome to wellcare changes to wellcares medicaid managed care plans 810 section 1. The fastest ways to get what you need are shown in the quick reference guide. Florida medicaid, childrens medical services health plan cms quick reference guide wellcare offers robust technology options to save you time. Legacy numbers include provider ids, medicaid and medicare ids, upin and state license numbers. Practitioner services coverage and limitations handbook april 2014 ii handbook use purpose the purpose of the medicaid handbooks is to educate the medicaid provider about policies and procedures needed to receive reimbursement for covered services provided to eligible florida medicaid recipients. The mma program was implemented in all florida regions as of august 1, 2014. These programs serve a variety of targeted populations. Applied behavior analysis provider manual chapter four of the medicaid services manual issued october 21, 2014 claimsauthorizations for dates of service on or after october 1, 2015 must use the applicable icd. This manual details our referral process, quality standards, credentialing and reimbursement process. The purpose of the medicaid handbooks is to educate the medicaid provider about policies and procedures needed to. April 1, 2014 page 4 of 118 2014 florida medicaid and healthy kids provider manual table of revisions date section comments page numbers 41 2014 section 1. The agency shall operate a program to oversee the activities of florida medicaid recipients, and providers and their representatives, to ensure that fraudulent and abusive behavior and neglect of recipients occur to the minimum extent possible, and to recover overpayments and impose sanctions as appropriate.
To request a printed copy of this manual, call provider services at. Prestige health choice is contracted with the agency for health care administration ahca as a participant in floridas. Revisions to this manual reflect changes made to wellcares policies and procedures. Agents available 7am to 6pm monfri 8am to noon sat 1pm to 5pm sun. Florida smmc mma and florida healthy kids provider manual. Healthease long term care program new section for providers in the healthease long term care program 99 1012012. Florida smmc ltc provider manual simply healthcare plans. In accordance with the policies and procedures clause of the agreement, participating wellcare providers must abide by all applicable provisions contained in this manual. Thank you for choosing the childrens medical services cms managed care plan for your health care needs. Therapy services provider manual section i introduction about eqhealth solutions effective.
Updates are generally available the month following the effective date of the change. The purpose of the medicaid handbooks is to provide the medicaid provider with the policies and procedures needed to receive reimbursement for covered services provided to eligible florida medicaid recipients. The fiscal agent will activate the recipients florida medicaid id number. We would like to show you a description here but the site wont allow us. Most medicaid recipients must enroll in a health plan that was selected through a competitive procurement to participate in the smmc program. It is referred to as the statewide medicaid managed care smmc program. Cf es form 2014, authorization for medicaidmedikids eligibility. The mma program was implemented in all florida regions on august 1, 2014.
Program policy manual florida department of children and. January 2014 proprietary about eqhealth solutions page 1 of 24 about florida medicaid the florida agency for health care administration the florida agency for health care administration ahca or agency is the single state agency. Medicaid also assists the elderly and people with disabilities with the costs of nursing facility care and other medical and longterm care expenses. The ccbs cannot pay additional money to the providers for the service that they are billing medicaid for e. This notice provides information about florida medicaid coverage limits and their. Provider manual florida statewide medicaid managed care. These units provide coordination of provider enrollment functions, provider data maintenance, outreach, education, and issue resolution to providers, the medicaid managed care. Florida medicaid and healthy kids provider manual effective.
Amerigroup would like to welcome you to the florida statewide medicaid managed care smmc managed medical assistance mma and florida healthy kids fhk provider network family. Home and community based services hcbs provide opportunities for medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. The texas medicaid provider procedures manual is the providers principal source of information about texas medicaid. The agency successfully completed the implementation of the statewide medicaid managed care smmc program in 2014. This form is available by photocopying it from the florida. Florida medicaid and healthy kids provider manual wellcare. Medicaid provider handbooks this handbook must be used in conjunction with the florida medicaid provider reimbursement handbook, cms1500 which contains information about specific procedures for submitting claims for payment, and the florida medicaid provider general handbook, which describes the florida medicaid program. The provider manual, as part of your provider agreement and related addendums, may be updated at any time and is subject to change. Community plan care provider manuals for medicaid plans by. Its our commitment to the members and providers we serve. Medicaid provider reimbursement handbook, ub04 ii july 2008 handbook use and format purpose the purpose of the medicaid handbooks is to provide the medicaid provider with the policies and procedures needed to receive reimbursement for covered services provided to eligible florida medicaid recipients.
Provider enrollment is comprised of three business units, the managed care, facility, and home and communitybased services unit, the practitioner and supplier unit, and the provider eligibility and compliance unit. Provider enrollment is responsible for enrolling qualified providers to receive medicaid reimbursement for services rendered to medicaid feeforservice recipients. Provider services fl agency for health care administration. It must be used in conjunction with the florida medicaid provider reimbursement handbook, cms1500, which contains information about specific procedures for submitting claims for payment, and the florida medicaid provider general handbook, which describes the florida medicaid program. Florida medicaid provider general handbook july 2012 ii handbook use and format purpose the purpose of the medicaid handbooks is to provide the medicaid provider with the policies and procedures needed to receive reimbursement for covered services provided to eligible florida medicaid recipients.
Community plan care provider manuals for medicaid plans by state the unitedhealthcare community plan care provider administrative manuals contain helpful information on topics such as prior authorization, processing claims and protocol information, as well as unitedhealthcare contact information and other resources. Temporary service authorization, ahca form 50003510, revised december 2012. Florida medicaids web portal solution provides communication and selfservice tools to the provider community. Amerigroup would like to welcome you to the florida statewide medicaid managed. Jun 16, 2016 providers medicaid npi number in both the billing and rendering fields. October 1, 2012 page 1 of 103 2012 florida medicaid provider manual table of revisions. Statewide medicaid managed care and florida healthy kids provider network. The interactive provider search tool allows you to search for a quality health care provider in your area. This provider manual does not apply to members of the medicare. This manual will provide you with information about molina and will describe how we will work together as you care for your patients health care needs.
Medicaid florida provider manual medicare pdf list. Providers can access the most current provider manual at. The manual is regularly updated to reflect the most recent policy and procedure changes. Florida statewide medicaid managed care managed medical. Florida medicaid and healthy kids provider manual effective,october 4, 2019 page 7 of 143 provider services toll free. Date section comments page numbers 712012 section xiv.
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