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Florida Medicaid Alerts

Florida Medicaid Health Care Alert – August 15, 2017

Provider Type(s): 01, 25, 26, 29, 30, 32, 34, 66, 69,70, 77,78

(Clarification) Long-Acting Reversible Contraceptive Inpatient Reimbursement (Fee-for-Service Delivery System)

In the fee-for-service delivery system, Florida Medicaid reimburses for immediate postpartum placement of long-acting reversible contraceptives (LARCs) separate from the inpatient hospital labor and delivery Diagnosis Related Group (DRG) payments. Medicaid health plans have the flexibility to negotiate mutually agreed upon reimbursement arrangements with their network providers. For more information on reimbursement of LARC devices immediate postpartum for health plan enrollees, please contact each health plan directly.


Providers rendering services through the fee-for-service delivery system can seek reimbursement for LARCs by utilizing the codes listed below. This reimbursement policy change became effective October 1, 2016 and was communicated to Medicaid providers via the updated Inpatient Hospital Services coverage policy, effective July 11, 2016. This system change was implemented to support the Agency’s goal of improving birth outcomes. Research shows that LARCs are effective in reducing unintended pregnancies, premature and low birth weight births, and prenatal drug exposure.

Devise Insertion and Removal Procedure Codes:

11981 Insertion, non-biodegradable drug delivery implants
11982 Removal, non-biodegradable d rug delivery implants
11983 Removal with reinsertion, non-biodegradable drug delivery implant
58300 Insertion of IUD
58301 Removal of IUD

LARC Device:


* systems are currently being updated to include this temporary code

Note: National Drug Codes (NDC) should be included. The only limit on these products is 1 unit per claim, up to 3 claims per year.

The Agency’s effort to facilitate access to LARCs immediately postpartum is in collaboration with community partners, Medicaid health plans and other state partners, which include the Florida Perinatal Quality Collaborative (FPQC). The FPQC has established the “Access LARC” Initiative to provide training and resources in efforts to help Florida hospitals set up delivery and billing systems needed for immediate postpartum placement of LARC implementation. If a hospital is interested in participating in this initiative, then visit the Access LARC website for more information.

Send an email to the Florida Perinatal Quality Collaborative at to obtain a list of recruited hospital contacts participating in this initiative.

If you need assistance, please contact a Medicaid representative at 1-877-254-1055.


Florida Medicaid Health Care Alert – January 2016

Provider Type(s): All

New Children’s Medical Services Plan Clinical Eligibility Process Begins January 11, 2016

Effective Monday, January 11, 2016, a new Florida Department of Health rule will govern how children can be determined clinically eligible for the Children’s Medical Services Medicaid Managed Medical Assistance plan (CMS plan). Under Rule 64C-2.002 of the Florida Administrative Code, treating physicians may attest to a current diagnosis and functional limitation qualifying children with chronic and serious conditions as a referral for enrollment into the CMS plan.

If you are the treating physician of a child and you would like to attest to the eligibility of your patient for the CMS plan, please review the CMS Clinical Eligibility Attestation for Physicians and a list of qualifying chronic and serious conditions. Completed and signed attestations can be submitted by the physician to the Department of Health via secure email at or via fax to (850) 488-3813. Please be sure to submit all five pages of the attestation.

NOTE: Friday, January 8, 2016, is the last day the Agency for Health Care Administration will process requests for enrollment in the Children’s Medical Services plan through the Interim Process to Qualify for Enrollment in the Children’s Medical Services Plan.

If physicians have questions about the CMS Clinical Eligibility Attestation, please contact a CMS plan nurse at (850) 245-4444, extension 3291.

General information about the CMS plan and available services is located at

Florida Medicaid Health Care Alert – December 2015

Provider Type(s): 70

Streamlined Credentialing Webinar Registration Now Available

The Agency for Health Care Administration has created a Streamlined Credentialing process, or Limited Enrollment, for providers seeking to participate in Medicaid managed care. The Limited Enrollment provider application captures demographic information for the applicant and the Agency will perform basic credentialing activities such as verifying licensure, exclusion databases, and background screening results in compliance with the Affordable Care Act provider screening requirements.

As of December 4, 2015, providers who do not hold a Medicaid ID and need to complete basic credentialing can submit a Limited Enrollment provider enrollment application through the Florida Medicaid Public Web Portal.

NOTE: Any provider who will submit FFS claims directly to Medicaid must be fully enrolled.

The Agency and their fiscal agent, Hewlett Packard Enterprise, invite the health plan community to participate in a series of upcoming webinars on the Streamlined Credentialing application. Webinars will take place on January 20, 2016 from 1:00-2:00 PM EST and January 21, 2016 from 2:00-3:00 PM EST.

To register, visit For questions or additional information, please contact

Florida Medicaid Health Care Alert – November 2015

Provider Type(s): All

Interim Process to Qualify Children for Enrollment In the Children’s Medical Services Plan

Children with chronic and serious conditions may choose to enroll in the Children’s Medical Services specialty plan (CMS plan). To qualify for enrollment in the CMS plan, the child’s physician must submit a letter to the Agency for Health Care Administration attesting that the child’s current diagnosis is one of the qualifying chronic and serious conditions listed below.

This is a time-limited process that will end once the Department of Health promulgates a rule specifying how children can qualify for the CMS plan.

The instructions for the physician’s attestation are on the Agency for Health Care Administration’s Medicaid Web pages for Recipient Support and Provider Services.

The Statewide Medicaid Managed Care contract for the CMS specialty plan defines chronic and serious conditions as one or a combination of the following conditions: acute or chronic lymphoid leukemia; acute or chronic myeloid leukemia; congenital or acquired quadriplegia; congenital diplegia or hemiplegia; spina bifida; malignant neoplasm of the esophagus, stomach, small intestine, pancreas, ovary, kidney, brain, unspecified part of the nervous system, or lung; human immunodeficiency virus (HIV) disease; persistent vegetative state; cystic fibrosis; heart failure; chronic kidney disease, stage IV and V; end stage renal disease; schizophrenia; major depressive disorder, recurrent, severe, with or without psychotic features; bipolar I disorder, severe; anorexia nervosa; bulimia nervosa; pyromania; intermittent explosive disorder; oppositional defiant disorder; failure to thrive – child; epilepsy, unspecified, without mention of intractable epilepsy; dysphagia; receptive-expressive language disorder; secundum atrial septal defect; perinatal chronic respiratory distress; or chronic respiratory failure.

Florida Medicaid Health Care Alert – September 2015

Provider Type(s): 01

Inpatient Stay Reprocessing

The Agency for Health Care Administration completed a review of Medicaid inpatient hospital claims, with dates of service from January 1, 2009 through June 6, 2014.

The Agency implemented a system enhancement in Florida Medicaid Management Information System, to correct the reimbursement of affected claims. As a result of the implementation, inpatient claims that were incorrectly reimbursed are being reprocessed for appropriate reimbursement. Providers affected by reprocessing will see claims adjusted in their Remittance Advice.

If you have any questions please contact Provider Services at (800) 289-7799 (option 7).

Florida Medicaid Health Care Alert – September 2015

Provider Type(s): 25, 26, 27, 28, 29, 30, 31, 34, 35, 36, 60, 61, 62, 63, 66, 68, 69, 70, and 77

Provider Fee Schedule Update

Effective September 3, 2015 the Florida Agency for Health Care Administration (AHCA) will be utilizing the rates published on the January 1, 2015 practitioner fee schedules. The January 1, 2015 fee schedules will be used until further notice. Claims reimbursed at the rates published on the August 1, 2015 fee schedules will be reprocessed in accordance with the rates specified on the January 1, 2015 fee schedules. Although not required, providers have the option of voiding and resubmitting their claim(s) ahead of the reprocessing.

The affected fee schedules are as follows:

  • Advance Registered Nurse Practitioner
  • Chiropractic
  • Dental General
  • Hearing
  • Independent Lab
  • Licensed Midwife
  • Optometric
  • Oral Maxillofacial Surgery
  • Outpatient Hospital Laboratory

  • Physician Assistant
  • Physician Evaluation and Management
  • Physician Laboratory
  • Physician Medical
  • Physician Radiology
  • Physician Surgical
  • Podiatry
  • Registered Nurse First Assistant
  • Visual

The January 1, 2015 fee schedules can be found at

For further questions regarding the fee schedule updates please contact Medicaid Program Finance at

Florida Medicaid Health Care Alert – July 2015

Provider Type(s): 70

Effective Dates for Providers Seeking to Register with Medicaid

The Agency for Health Care Administration has directed the Medicaid fiscal agent, HP Enterprises, LLC, to set the effective date for newly-registered providers to the date the registration is received, in keeping with 409.907, F.S. The change is effective for registrations received after July 1, 2015.

The previous exception to effective dates which allowed the effective date for newly-registered providers to be one year prior to receipt of the registration is sunset. This exception was enforced throughout the implementation of Statewide Medicaid Managed Care to support the rapid development of health plan networks which required the assignment of Medicaid IDs to many providers.

This action is taken with consideration for health plans who may contract with a provider who supplies services to Medicaid eligible recipients prior to registering with Medicaid. On a case-by-case basis, health plans can submit a written request for consideration of an effective date equal to the first date of service. The request should be included with the registration form when submitted to the Medicaid fiscal agent. The request will be reviewed by Agency staff who will instruct the fiscal agent when an exception to the date of receipt effective date rule will be granted.

If plans have any questions regarding this message, please contact the Provider Enrollment Contact Center at 1-877-289-7799, Option 4 for assistance.

Florida Medicaid Health Care Alert – July 2015

Provider Type(s): 25, 26, 27, 28, 29, 30, 31, 34, 35, 36, 60, 61, 62, 63, 66, 68, 69, 70, and 77

Provider Fee Schedule Update

Florida’s 2015 Special Legislative Session A concluded on June 19, 2015, resulting in a delay of budget finalization. Fee schedules for state fiscal year 2015-16 could not have been updated prior to final action by the Legislature and Governor on the state budget for the fiscal year. As a result, the following fee schedules will be updated with an effective date of August 1, 2015:

  • ARNP
Physician Immunization
  • Birth Center
  • Physician Laboratory
  • Chiropractic
  • Physician Medical
  • Dental General
  • Physician Pediatric Spec
  • Dental Injectables
  • Physician Primary Care Rates
  • Hearing
  • Physician Radiology
  • Independent Lab
  • Physician Surgical
  • Licensed Midwife
  • Physician Durable Medical Equipment
  • Optometry
  • Podiatry
  • Oral MaxFac
  • RNFA
  • Physician Anesthesia
  • RPICC Neo
  • Physician Assistant
  • RPICC Ob
  • Physician E&M
  • Visual

Florida Medicaid Health Care Alert – May 2015

Provider Type(s): All: National Provider Identifier (NPI) to Medicaid ID Search Engine

The Agency for Health Care Administration in conjunction with the Medicaid fiscal agent, HP Enterprises, LLC, has developed an online National Provider Identifier (NPI) to Medicaid ID Search Engine which allows users to search by an NPI and view the Medicaid IDs with which it is associated.

With this information, users can determine, before a claim is submitted and possibly denied, if the NPI they will be listing at either the rendering or billing level will result in a single unique match to a provider ID in the FLMMIS. An NPI as submitted in a claim must match to a single provider ID in order for the claim to pass the edits which verify that the provider is an active Medicaid provider.

If the search reports multiple provider IDs, users may add groupings of NPI, Taxonomy, and/or ZIP+4 to the search in an attempt to locate a single match. Regarding use of these elements in claims:

  • For billing submissions, a combination of an NPI, Taxonomy, and Zip code can be used on claims to find a unique match to a provider file.
  • For rendering submissions, only the NPI and Taxonomy can be used. The NPI search tool was created to allow for these differences.

Note: Only active NPIs that have an end date within the last year or later are displayed in the search results.

Accessing the NPI to Medicaid ID Search Engine

The NPI to Medicaid ID Search Engine can be found on the Medicaid Public Web Portal at The application can be accessed from either the Support section of the Provider Services drop-down menu or from the Managed Care menu accessed by clicking the Managed Care link.

For further assistance with inquiries related to this announcement, email

Florida Medicaid Health Care Alert – May 2015

Provider Type(s): All: Children’s Medical Services Clinical Screening

The Florida Department of Health is implementing a new, national screening tool for children with special health care needs that is used by several other states. The timeline for screening children in Medicaid (Title 19) CMSN will begin in May, and is as follows below. Children in Title 21 (CHIP) will be not be re-screened until August or September 2015.

For Title 19 (Medicaid) Re-Screening:

May: Families with children in CMSN receive a letter informing them of the screening process.

May through July: Screenings with the new tool take place via telephone call to families. Children determined not to meet CMSN clinical criteria receive a letter explaining the next steps and then receive materials from Medicaid with information on how to choose a new Managed Medical Assistance plan. All children will have a minimum of 30 days to choose a plan.

July through September: Children who are not clinically eligible for CMSN begin being served by new MMA plans. The start date of enrollment is based on when the screening was completed.

Every Managed Medical Assistance plan provides all medically necessary services to children, so families can choose plans based on factors such as which providers are in the network and what extra benefits the plan provides. If families have more than one child on Medicaid and wish to have their children served by the same health plan, there are options available. Families should call Medicaid Choice Counseling for more information.

The following protections apply for any Medicaid recipient who changes health plans:

  • Health care providers should not cancel appointments with current CMSN patients. Health plans must honor any ongoing treatment that was authorized or scheduled prior to the recipient’s enrollment into the new health plan for up to 60 days after the child enrolls in the plan.
  • Providers will be paid. Providers should continue providing any services that were previously authorized, regardless of whether the provider is participating in the plan’s network. Plans must pay providers for previously authorized services for up to 60 days, and must pay non-network providers at the rate previously received for up to 30 days.
  • Prescriptions will be honored. Plans must allow recipients to continue to receive their prescriptions through their current provider, for up to 60 days, until their prescriptions can be transferred to a provider in the plan’s network.

For more information, please visit the Florida Department of Health website.

Florida Medicaid Health Care Alert: April 2015

Provider Type(s): All – Medicaid Eligibility for Newborn Babies

A new Medicaid information document entitled “Medicaid Eligibility for Newborn Babies” is now available on the Florida Medicaid Public Web Portal.

The publication covers basic information on newborn eligibility and activation:

  • Unborn Activation Process
  • Enrollment in a Managed Medical Assistance Plan
  • Enrollment in an MMA Specialty Plan
  • Voluntary Change of MMA Plan for Baby
  • Not Enrolled in MMA Plan
  • Unborn Does Not Have a Medicaid Number
  • Newborn FAQs

The document may be found on the Statewide Medicaid Managed Care web page and on the Medicaid Policy and Quality web page.

Florida Medicaid Health Care Alert: April 2015

Provider Type(s): 01 and 70 – Updated Outpatient Laboratory Fee Schedule

The Agency for Health Care Administration has published the new Outpatient Hospital Laboratory fee schedule; with an effective date of January 2015. The updated fee schedule can be found at Select Provider Services and then under Support select Fee Schedules.

The 2015 Outpatient Laboratory fee schedule will no longer include follow-up days (FUD) or units of service (UOS). Florida Medicaid utilizes the National Correct Coding Initiative Medically Unlikely Edits (MUE) for units of service.

Providers receiving reimbursement through a Medicaid managed care plan should refer to their contract with each plan to determine whether this change will impact their reimbursement from the plan.

Florida Medicaid Health Care Alert: April 2015

Agency Disclosure of Provider/Recipient Information

In accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations, Agency representatives are not allowed to disclose provider claim or other information, including recipient protected health information (PHI) to individuals who are not authorized representatives of a Medicaid provider. Authorized representatives include the provider’s employees and any registered billing agents with a Medicaid provider ID (provider type 99).

To receive provider information, the billing agent must also be associated with the provider’s file through the submission of an Electronic Data Interchange (EDI) agreement. Providers may not use an unrelated third-party who is not enrolled in Medicaid as a billing agent. Please contact Medicaid Provider Enrollment at 1 (800) 289-7799, option 4, for information on enrolling as a Medicaid billing agent, or linking to a provider file as a trading partner.

Agency representatives will not disclose any provider information to parties who do not meet the criteria described above.

Ebola Alert for Providers

October 9, 2014 – Florida’s Agency for Health Care Administration (AHCA) released a statement to providers and health plans in the state of Florida regarding Ebola and standard reporting procedures for communicable diseases in the state of Florida. As noted in the letter, “Much of this information has already been delivered to individual providers (physicians, laboratories, hospitals, etc.) by the Florida Department of Health.  It is our intent to keep our Agency partners informed and encourage the dissemination of this information as broadly as you deem appropriate.”

AHCA’s list of resources for providers includes those from the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the Florida Department of Health:

Centers for Disease Control and Prevention:

Signs and Symptoms, Transmission, Prevention, Information for Health Care Workers, One Page Fact Sheet 

World Health Organization: 

Protective Measures for General PublicProtective Measures for Medical Staff

Florida Department of Health: 

Ebola Overview (Video), Ebola Guidance Flyer (English/Spanish)

The following sources, taken from the Florida Department of Health, provide information regarding health care provider reporting guidelines for communicable diseases.

Health Care Practitioner Reporting Guidelines • List of Reportable Diseases/Conditions in Florida • Practitioner Disease Report Form

Additionally, DOH Letter 7-1-14 from the Florida Department of Health informs providers of the most recent changes to regulations pertaining to the reporting of communicable diseases in Florida. AHCA has asked that health organizations disseminate this information to healthcare providers and others. AHCA will continue to issue updates as appropriate.

Medicaid Alert Regarding State Licensure for Health Care Clinics

State licensing laws requires that health care clinics, unless specifically exempt from the requirement, be licensed by the Agency pursuant to Chapter 400, Part X, Florida Statutes. The statute defines a clinic as “an entity at which health care services are provided to individuals and which tenders charges for reimbursement for such services, including a mobile clinic and a portable equipment provider.” It is the responsibility of the provider to know if their clinic is required to be licensed. It is improper to operate without a health care clinic license when one is required by law.

For more information about whether a license is required or whether you qualify for an exemption, visit the Agency’s website. Specific exemptions can be found by viewing the “Health Care Clinic Act” link on the website; specifically chapter 400.9905, 4(a)-(n), F.S.

The Agency is increasing efforts to ensure compliance with these provisions of law and encourages all Medicaid providers to review the law and take appropriate action to assure compliance. Failure to comply with the licensure requirements may result in sanctions as well as recovery of any overpayments. The Agency’s licensing Division of Health Quality Assurance (HQA), also monitors compliance and take action for unlicensed activity as appropriate.

Questions specific to the increased compliance efforts by HQA may be directed to the Health Care Clinic Unit via email at or by phone at (850) 412-4404.

For more information on the Medicaid program and Medicaid policies, contact your local Medicaid area office. Additionally, information about self audits and other compliance-related issues may be found on the Agency’s website, including the Medicaid Fraud and Abuse link and the Medicaid Training e-Library.

Message from the Florida DOH Regarding ICD-10

ICD-10 is fast approaching. The Centers for Medicare and Medicaid Services has an excellent website “Road to 10” available at no cost. Resources are available with downloadable ICD-10 files. Please visit for information.

Florida Medicaid Healthcare Alert: Important Change in Background Screening Process for Florida Medicaid

Background screening for new and renewing Medicaid providers will migrate to the Care Provider Background Screening Clearinghouse effective March 1, 2015.

The purpose of the Clearinghouse is to provide a single data source for background screening results of persons required to be screened by law for enrollment in Florida Medicaid. The Clearinghouse shall allow the results of criminal history checks to be shared among specified agencies when a person has applied to volunteer, be employed, be licensed, or enter into a contract that requires a state and national fingerprint-based criminal history check. (section 435.12, Florida Statutes).

A new Florida Medicaid ORI (EAHCA013Z) will take effect March 1, 2015. This ORI requires retained prints and a photograph. The new cost of the screening is $62.75 plus any handling fees charged by the Livescan vendor submitting the screening for the provider. The existing ORI (FL922013Z) will be invalid as of March 1, 2015 and WILL BE denied. If a submission is denied, providers must complete and pay for a new fingerprint using the new ORI (EAHCA013Z).

Medicaid providers are required to register applicants on the Clearinghouse website prior to screening; this will create a screening ID, or screening request ID, for use by Livescan vendors and providers. The new ORI will be passed to the Livescan vendor/service provider if an appointment is scheduled via the Clearinghouse website.

Clearinghouse website information is available on the AHCA public portal.

Florida Medicaid Health Care Alert: February 2015

Provider Type(s): 67 • Upcoming Changes to Agency for Persons with Disabilities Provider Background Screening Process

Florida Medicaid is transitioning background screening for new and renewing applicants to the ‘Care Provider Background Screening Clearinghouse’ or ‘Clearinghouse’ (CLH) effective March 2, 2015.

The purpose of the CLH is to provide a single data source for background screening results of care providers. It allows participating ‘Specified Agencies’ to share the results of criminal history checks when a person has applied to volunteer, be employed, be licensed, or enter into a contract that requires a state and national fingerprint-based criminal history check. This message will clarify how this transition affects APD providers.

When will APD providers start using the Clearinghouse?

APD providers will receive an email notification with instructions and training materials when it is time to register for the CLH results website. APD providers will register in phases by provider type (e.g., APD MW, APD Facility) as part of the DCF/APD on boarding phase scheduled for spring and summer 2015.

Please note:

  • Providers should ensure that DCF/APD has a current email address to receive notifications.
  • Providers will have time to register and view training videos posted online.
  • APD providers should continue to submit screenings under the existing system as normal until registration is complete and they receive another notification to use the Results Website.

Are providers required to screen all existing employees again through the CLH?

No. Providers will continue normal screening practices for new hires, existing employees at their 5-year rescreening date, and those with a lapse in employment that meets rescreening standards.

Providers with questions about this new process may visit DCF’s Background Screening webpage at The webpage offers more information on the Clearinghouse, along with step- by- step instructions on the process to begin submitting screenings through the Clearinghouse. Providers may also call the DCF Background Screening Help Desk at (888) 352-2842.

Florida Medicaid Health Care Alert, February 2015: From Florida Medicaid, A Division of the Agency for Health Care Administration

The February ICD-10 Newsletter is now available on the Florida Medicaid Public Web Portal.

You can download a copy of the February 2015 ICD-10 Newsletter under the Publications section of the ICD-10 pages.

In this issue:

  • ICD-10 Workshops and Webinars
  • Coding for ICD-10-CM: More of the Basics
  • Getting Ready for ICD-10 with CMS Resources
  • Community Behavioral Health – Autistic Disorder, Asperger’s Syndrome, etc.

The ICD-10 pages are updated often, so please visit regularly for the most current information.