In addition to writing corrected on the claim, the corrected information should be circled so that it can be identified. Nassau, Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. The benefit information provided is a brief summary, not a complete description of benefits. To sign up for Medicaid online, petitioners must create an online account. P.O. 2021, in which services continue after May 1, 2021. Parents, remember that well-child visits are very important during the COVID-19 pandemic. Florida Department of Children and Families ACCESS Florida provides the info on the next page. You are enrolled in our SMMC plan, the CMS Health Plan. Medicaid Office Location Florida Agency for Health Care Administration 2727 Mahan Drive Tallahassee, FL 32308 Medicaid Office Phone Number The phone number to call the Florida Medicaid office is 888-419-3456. Duval, When you send a reconsideration, be sure to include: We cant accept COB reconsiderations via electronic transmission. 800-477-6931 (TTY: 711) Log in to the Provider Portal to check the status of your enrollment(s). The QRGs include targeted claims and authorization instructions per provider type. Your Long Term Care plan, Staywell Health Plan, is joining Sunshine Health. Help your child grow by protecting them against vaccine-preventable diseases. For those who have questions about Medicaid eligibility requirements, applying for Medicaid in person may be the best option, as there are representatives to assist with the process. 727-939-2500. Or choose Go on to move forward. Sumter, Attention Deficit Hyperactivity Disorder (ADHD). The guides detail billing guidelines, duplicate billing, corrected claims processes and many more topics. Under the SMMC program, most Medicaid recipients are enrolled in a health plan. For those interested in electronic claim filing, contact your EDI (Electronic Data Interchange) software vendor or the Availity Provider Support Line at 800-282-4548 to arrange transmission. I understand that my information will be used in accordance with my plan notice of privacy practices. Volusia. If you have purchased an association plan, an association fee may also apply. Stay up to date on any provider notices by bookmarking and reviewing Provider News. For information on local resources and community and supportive services in your area Another group or vendor provides the info on the next page. Frequently asked questions Newborns will be automatically enrolled in their mothers plan at the time of birth. Some network providers may have been added or removed from our network after this directory was updated. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability. Florida Medicaid Fair Hearing. We have an extensive list of eye doctors available to help you. Plus, our provider network is growing to give you even more choices. Nothing is more important than taking care of you and your family. You will need Adobe Reader to open PDFs on this site. You get to keep the same great benefits, plus get more benefits from Sunshine Health. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to: Civil Rights Coordinator UnitedHealthcare Civil Rights Grievance If you have questions, find the number you need to get help and support. Influenza, commonly called the flu, is a serious illness that can spread easily. Floridas Medicaid program is called the Statewide Medicaid Managed Care (SMMC) Program. Provider Billing Manual - Florida Medicaid & Health Insurance We value our partnership and are here to help. Eligibility UnitedHealthcare continues to partner with state and local public health departments, following guidance and protocols appropriate to our members that are provided by the U.S. Centers for Disease Control and Prevention (CDC), and state and local public health departments that are appropriate for our members. Florida Medicaid. Your billing department will need to submit to the appropriate payer to prevent payment delays. The Florida Medicaid Plans offer a range of benefits along with extras that you may find useful. Electronic claim submission (EDI) is the preferred method for fast and accurate processing. All health plans hospice information (PDF), Hospice guidelines Medicaid and Long-Term Care services (PDF), Centers for Medicare & Medicaid Services (CMS) ICD-10 resources, Conversion tool for Diagnostic and Statistical Manual of Mental Disorders(DSM-5) to ICD-10 (PDF). Date: 08/31/21 Fort Lauderdale, Florida Centene's acquisition of WellCare's Medicaid products, including Staywell Health Plan, will be complete Oct. 1, 2021. You can also enroll online at flmedicaidmanagedcare.com. (This fee is non-refundable as allowed by state). 7:30 AM - 6 PM ET. 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. Talk to your UnitedHealthcare network doctor about getting the flu shot. The benefit information provided is a brief summary, not a complete description of benefits. Box 195560 San Juan, PR 00919-5560 Payment integrity & disputes Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members eligible for the United Healthcare discount program. The benefit information provided is a brief summary, not a complete description of benefits . Salt Lake City, UTAH 84130 Claims coding Claims payment policies Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Every year, Medicare evaluates plans based on a 5-Star rating system. Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc., or insured by Humana Health Insurance Company of Florida, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Insurance Company, Humana Insurance Company of Kentucky, Humana Insurance of Puerto Rico, Inc. License # 00187-0009, or administered by Humana Insurance Company or Humana Health Plan, Inc. For Arizona residents, plans are offered by Humana Health Plan, Inc. or insured by Humana Insurance Company. To Learn More About UnitedHealthcare Community Plan. Humana Individual dental and vision plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or Humana Health Benefit Plan of Louisiana, Inc. Discount plans offered by HumanaDental Insurance Company or Humana Insurance Company. 813-392-5303 (TTY: 711) Since there is no main location for the department, you will need to know where to apply for Florida Medicaid or pick up an application by finding the local office in your area. Visit the Agency for Health Care Administrations website where you can viewour health plans performance measure results and compare with those of other health plans. Statewide Medicaid Managed Care (SMMC) provides the infoon the next page. If you are denied Medicaid enrollment, you have the right to file an appeal with the Florida Medicaid program, which will require program officials to review your application. Attn: Appeals Department Use FL Medicaid Member Portal secure messaging. You can file a claim reconsideration by mail: Mail your claim adjustment request/claim reconsideration form and all supporting documents to: All ABHFL EFT/ERA Registration Services (EERS) are managed by Change Healthcare. ${plan_name} complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Receiving calls and/or text messages from Aetna Better Health ofFloridathat are informational and relate to my health and benefits. If youre affected by a disaster or emergency declaration by the President or a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you. Humana Healthy Horizons in Florida is a Medicaid product of Humana Medical Plan, Inc. Benefits, formulary, pharmacy network, premium, and/or copayments/co-insurance may change. P.O. Prospective applicants wondering where to apply for Medicaid in FL may be surprised about the methods and locations available for signing up for government assistance. The Medicaid MMA & LTC plan specialists can answer questions and help you enroll. Offer not available on the following items: photo orders, prescriptions, tobacco, dairy, alcohol, liquor departments, phone/prepaid/gift cards, money orders/transfers, transportation passes, lottery tickets, charitable donations, pseudoephedrine or ephedrine products, newspapers, magazines, stamps, home medical equipment and durable medical equipment products, pharmacy items and services, Prescriptions Savings Club membership fee, and items or services submitted to insurance for reimbursement or where otherwise limited by law. Staywell Health Plan (Staywell) provides health care and long-term care services to people who qualify for Florida Medicaid. Contact Us. There may be providers or certain specialties that are not included in this application that are part of our network. Explains how to receive, load and send 834 EDI files for member information. To prove financial eligibility to enroll in Medicaid, applicants income will need to be verified with items like a W-2 form or paystubs. The final replacement claims be billed for the complete stay from the first date of admission through the date of final discharge. You must send the complaint within 60 days of when you found out about it. Failure to follow these instructions may result in eligibility rejections. For costs and complete details of the coverage, call or write your insurance agent or the company, whichever is applicable. service, care coordination, provider relations, and claims payment. Humana legal entities that offer, underwrite, administer or insure insurance products and services, Be completely vaccinated against COVID-19 (number of doses depends on persons age), Sign in to their Go365 for Humana Healthy Horizons account, Upload an image of their completed vaccination card. Date: Box based on date of service guidance below. For costs and complete details of the coverage, refer to the plan document or call or write Humana, or your Humana insurance agent or broker. Mon Fri 8am 7pm. What is the claims mailing address for Florida Medicaid? Limitations, copayments, and/or restrictions may apply. Plus, our provider network is growing to give you even more choices. Sunshine Health will also operate the Department of Healths Children's Medical Services Health Plan beginning Oct. 1, 2021. View the overview PDF to help you to decide which plan pays for a service, Overview of the Dental Component of the Statewide Medicaid Managed Care Program (97 KB), PDF opens in new window, CenterWell Pharmacy 1. You must file claims within 180 days of the date you provided services, unless theres a contractual exception. Looking for the federal governments Medicaid website? Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services. Newborns will be automatically enrolled in their mothers plan at the time of birth. Claims and encounter submission Claims processing edits View notifications of updates made to our claims payment systems and see notifications of upcoming changes. Eligible recipients will have 120 days to choose a managed care plan in their region. Sunshine Health is a managed care plan with a Florida Medicaid contract. Call Florida's enrollment broker to enroll, disenroll, or ask questions: 1-877-711-3662 (TTY: 711). Reimbursement Policies. 727-804-7439. or. Plans that are low cost or no-cost, Medicare dual eligible special needs plans In most cases, your care manager and your providers will stay the same. Box 982960 Reimbursement Handbooks describe how to complete and file claims for reimbursement from Medicaid. Guidelines for proper claims submissions effective October 1, 2021 Centene's acquisition of WellCare's Medicaid products, including Staywell Health Plan, will be complete October 1, 2021. . Claim Payment Disputes In most cases, your care manager and your providers will stay the same. If billing a professional or an outpatient bill type institutional submission, please use the earliest from date in the claim submission as outlined below. A key factor in getting claims processed in a timely manner is correct claims submission, and ABH FL provides multiple options for you to choose from, including the sending of paper claims through the mail. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Vivida encourages all providers including non-par providers to submit claims electronically. For group plans, please refer to your Benefit Plan Document (Certificate of Coverage/Insurance or Summary Plan Description/Administrative Services Only) for more information on the company providing your benefits. Your MyHumana account is here when you need it. Print ID cards, chat with a nurse online, and more. 4 CO specific: $3 copays for Preferred generic drugs or something similar. (Ex: 01, 02, 20 etc.). As of December 6, 2021, Sunshine Health providers will notice an increased frequency in their payment schedule. Clay, And because we're a five-star plan, you can enroll year-round. Please contact our customer service number at: MMA:1-888-716-8787| LTC:1-800-791-9233| TTY: 711 | 24 hours a day. After submitting their Medicaid application, most applicants will receive information about their enrollment status in about a months time. In the event of a dispute, the policy as written in English is considered the controlling authority. . Our Medicaid (MMA) plan covers children, families, pregnant women and single adults who may qualify based on income. Bradford, Our NEW address will be effective . Your submission will be directed to our call center where someone will review your request and respond within 2 business days. Use the form below to submit a question, comment, or complaint. The benefit information provided is a brief summary, not a complete description of benefits. Or just contact us. Staywell Health Plan is Joining Sunshine Health! Walgreens discount valid until 12/31/23. Medicaid. Hillsborough, Please review plan details to learn more. The guides detail billing guidelines, duplicate billing, corrected claims processes and many more topics. Monroe, We aim to help improve the health and well-being of children and adults across the state, while helping you provide quality care. Heres the good news: a simple shot can reduce your chances of getting influenza and its available to you at no cost with your UnitedHealthcare Community Plan. Call Floridas enrollment broker to enroll, disenroll, or ask questions: 1-877-711-3662 (TTY: 711). Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. For more information contact the plan or read the Member Handbook. View and update your address; Request help using secure messaging; . Transportation services are coordinated through the Care Management team For more information, contact the Managed Care Plan. Humana Healthy Horizons is more than a health plan. See our full accessibility rights information and language options. This communication provides a general description of certain identified insurance or non-insurance benefits provided under one or more of our health benefit plans. WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States. This new name reflects our goal to help our members achieve their best health and live their best lives. For paper claims, please submit to Vivida at the following address: Vivida Health PO Box 211290 Eagan, MN 55121 The benefits of submitting EDI claims include: Improved cost effectiveness Improved claims tracking Electronic acknowledgment of claim receipt Faster payment of claims Better turnaround time for timely reimbursement Find out how to submit claims through Electronic Data Interchange (EDI) for faster, more efficient claims processing and payment. Providers and Agents. Corrected and resubmitted paper claims are scanned during reprocessing. To find out if you are eligible, or to locate a CARES unit near you, call the Elder Helpline:1-800-963-5337. 110 Athens St. suite M. Tarpon Springs, Fl 34689. Plans that provide special coverage for those who have both Medicaid and Medicare. February 14th, 2022. Want to learn about who we are? In an emergency, call 911 or go to the nearest emergency room. Email FLMedicaidResolution@humana.com, 800-229-9880 (TTY: 711) A paper Medicaid application form is available for applicants who prefer not to use the internet to apply for Medicaid. Medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, KS, LA, MO, and TN; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of Texas, Inc.; and UnitedHealthcare of Oregon, Inc. in WA. Do you or someone you know have Medicaid and Medicare? Claims and Billing. If you dont want to leave the member site, choose the X in the upper right corner to close this message. Or choose Go on to move forward. Enrollees will have 90 days after enrollment to choose a different plan. 2021, should be sent to Miami Children's electronically or by mail. This means that we will offer you Medicaid services. Limitations, co-payments and restrictions may apply. Paper claims Miami Children's Health Plan P.O. Humana Healthy Horizons in Florida Medical Plan Florida DOH partners with WellCare of Florida (WellCare) to operate the CMS Health Plan. You can check your provider manual. 24 hours a day, 7 days a week. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. If you need help finding contact information for your plan, call our Medicaid Helpline at 1-877-254-1055 or visit www.ahca.myflorida.com/Medicaid. If billing a professional submission with services spanning before and after Oct. 1, 2021, please split the services into two separate claim submissions as outlined below. Please review the guidance below and update your system accordingly. Please follow the guidelines below to help prevent any claim payment delays. Out-of-network/non- contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. TTY/TDD users please call 1-866-467-4970. More information on eligibility and enrollment can be found on theFlorida Medicaidwebsite. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Per informazioni in lingue alternative, seleziona il link del nome del piano appropriato qui di seguito. Call the Medicaid Choice Counseling Hotline at 1-877-711-3662 or visit www.flmedicaidmanagedcare.com. Valuable information and tips to help those who care for people with both Medicaid and Medicare, Medicaid This service should not be used for emergency or urgent care needs. Claim adjustment request/claim reconsideration form (PDF), claim adjustment request/claim reconsideration form (PDF), Change Health payer enrollment services website, An updated copy of the claim all lines must be rebilled, A copy of the original claim (reprint or copy is acceptable), A copy of the remittance advice on which we denied or incorrectly paid the claim, A brief note describing the requested correction, A copy of the remit/Explanation of Benefits (EOB) page for each resubmitted claim, with a brief note about each claim youre resubmitting, Any information that the health plan previously requested. CMCS Medicaid and CHIP All State Calls 2023 All State Calls 2022 All State Calls 2021 All State Calls 2020 All State Calls Medicaid Medicaid State Plan Amendments Access to Care Access Monitoring Review Plans Program Integrity National Correct Coding Initiative Affordable Care Act Program Integrity Provisions Cost Sharing Cost Sharing Exemptions Sunshine Health is a managed care plan with a Florida Medicaid contract. Non-members may download and print search results from the online directory. Find out how you can enroll Or compare plans. You can also mail hard copy claims or resubmissions to: Aetna Better Health of Florida PO Box 982960 El Paso, TX 79998-2960 Likewise, adults older than 21 years of age will also not have to list any adult relatives including their parents on their Medicaid form if they are filing taxes separately. The benefits described may not be offered in all plans or in all states. Humana Healthy Horizons in Florida members 6 months old and older can qualify to earn $20 in rewards through Go365 for Humana Healthy Horizons after getting a COVID-19 vaccine. Florida's Agency for Health Care Administration (AHCA)provides the info on the next page. TTY/TDD users please call1-866-467-4970. With each subsequent inpatient hospital billing the previous claim is voided and replaced with a new claim. Baker, If CMS hasnt provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration. Humana is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. (Humana Entities). Eagan, MN 55121. Claims processing edits Claims coding Download claim coding and payment inquiry process guidelines. Eligible Medicaid recipients will receive a letter with enrollment information, including information on how to enroll. Levy, Virtual visits conducted by telephone or video chat with a doctor are not an insurance product, health care provider or a health plan. You get to keep the same great benefits, plus get more benefits from Sunshine Health. St. Johns, Discount cannot be used online. The offices contact information Where in Florida the facility is located If the Lakeland Medicaid office has a website. Hamilton, Process and decide claims within 30 days of receipt This includes: Processing clean payments for professional and institutional claim submissions, Process and decide claim reconsiderations within 120 days of the resolution date on the original (clean) claims EOB, Identify a Coordination of Benefit (COB) resubmission as a claim previously denied for other insurance info, or originally paid as primary without coordination of benefits, Process and decide COB claim reconsiderations within 95 days from the disposition date on the primary carriers EOB or response letter, Reduced manual posting of claim payment info, which saves you time and money, while improving efficiency, No need for paper Explanation of Benefits (EOB) statements.