This webinar serves to educate long-term care providers on the process for enrolling to become Medicaid providers under the Statewide Medicaid Managed Care and other Medicaid programs.
All product and company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
This presentation discusses Assisted Living Faciltiies (ALFs) and Adult Family Care Homes (AFCHs) and how they fit in to the new Long-term Care program under Statewide Medicaid Managed Care.
This SMMC provider webinar talks about the implications for recipients who are eligible for both the Long-term Care and Managed Medical Assistance programs.
All product and company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
This presentation discusses Assisted Living Faciltiies (ALFs) and Adult Family Care Homes (AFCHs) and how they fit in to the new Long-term Care program under Statewide Medicaid Managed Care.
This SMMC provider webinar talks about the implications for recipients who are eligible for both the Long-term Care and Managed Medical Assistance programs.
Compliance and Legal Risks in Laborist, Surgicalist, and Hospitalist Arrangem...MD Ranger, Inc.
Have you structured your hospital-based physician contracts to address all aspects of compliance?
Hospitalist agreements involve unique compliance and financial issues, particularly when global payments and advanced practice providers are involved. Risks include indirect compensation, billing and other compliance issues. This presentation will discuss compliance risks and provide guidance on how to structure compliant contracts and business arrangements.
HIPAA: How to avoid becoming a worst case scenario ContentBacon
Danna-Gracey.com
Learn about key HIPAA issues including:
- Where the fines are coming from
- Common causes of breaches
- Success and horror stories
- Suggestions to keep your organization safe
- Insurance coverage for HIPAA issues
7 legal issues associated with telemedicine servicesmosmedicalreview
Like traditional medicine, telehealth also involves medical chart reviews and other investigations. There are certain legal issues related to telemedicine.
The Medicare Diabetes Prevention Program (MDPP) Expanded Model team provided a tutorial about enrollment in the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
All information, data, and material contained, presented, or provided on is for educational purposes only.
Company names mentioned herein are the property of, and may be trademarks of, their respective owners.
It is not to be construed or intended as providing legal advice.
There are three main strategies for billing: becoming credentialed as a provider, obtaining preauthorization before submission, and submitting the claim without prior authorization. If a pharmacist is credentialed with the insurance carrier, he or she is already authorized to submit claims to the insurance company for those patients using the pharmacist’s program.
When Enrollment Goes Wrong: Successfully Navigating and Avoiding the Pitfalls...Polsinelli PC
This presentation will provide a brief overview of the Medicare enrollment process for different types of providers and suppliers. We will address the nuts and bolts of obtaining access to PECOS – the electronic Medicare enrollment database, best practices in compliance monitoring, and the consequences of not correctly addressing enrollment issues on the front-end. Our discussion will use specific examples to demonstrate when enrollment goes wrong.
This webinar will discuss:
-Consequences of Improper Enrollment
-Understanding the Enrollment Process and resources related to
-Develop internal expertise and Standard Practices
-Medicare Overview, 855 submission and when enrollment goes wrong
This SMMC provider webinar talks about specialty plans involved in the SMMC program. These plans are designed to provide services tailored for individuals with a particular diagnosis, such at HIV/AIDS, Mental Illness, CHF, COPD, or Diabetes.
This presentation is designed to provide an overview of the choice counseling process and how it can benefit long-term care recipients in the State of Florida.
This presentation outlines the specific requirements for Hospice providers with respect to the Statewide Medicaid Managed Care (SMMC) Long-term Care program in Florida.
Compliance and Legal Risks in Laborist, Surgicalist, and Hospitalist Arrangem...MD Ranger, Inc.
Have you structured your hospital-based physician contracts to address all aspects of compliance?
Hospitalist agreements involve unique compliance and financial issues, particularly when global payments and advanced practice providers are involved. Risks include indirect compensation, billing and other compliance issues. This presentation will discuss compliance risks and provide guidance on how to structure compliant contracts and business arrangements.
HIPAA: How to avoid becoming a worst case scenario ContentBacon
Danna-Gracey.com
Learn about key HIPAA issues including:
- Where the fines are coming from
- Common causes of breaches
- Success and horror stories
- Suggestions to keep your organization safe
- Insurance coverage for HIPAA issues
7 legal issues associated with telemedicine servicesmosmedicalreview
Like traditional medicine, telehealth also involves medical chart reviews and other investigations. There are certain legal issues related to telemedicine.
The Medicare Diabetes Prevention Program (MDPP) Expanded Model team provided a tutorial about enrollment in the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
All information, data, and material contained, presented, or provided on is for educational purposes only.
Company names mentioned herein are the property of, and may be trademarks of, their respective owners.
It is not to be construed or intended as providing legal advice.
There are three main strategies for billing: becoming credentialed as a provider, obtaining preauthorization before submission, and submitting the claim without prior authorization. If a pharmacist is credentialed with the insurance carrier, he or she is already authorized to submit claims to the insurance company for those patients using the pharmacist’s program.
When Enrollment Goes Wrong: Successfully Navigating and Avoiding the Pitfalls...Polsinelli PC
This presentation will provide a brief overview of the Medicare enrollment process for different types of providers and suppliers. We will address the nuts and bolts of obtaining access to PECOS – the electronic Medicare enrollment database, best practices in compliance monitoring, and the consequences of not correctly addressing enrollment issues on the front-end. Our discussion will use specific examples to demonstrate when enrollment goes wrong.
This webinar will discuss:
-Consequences of Improper Enrollment
-Understanding the Enrollment Process and resources related to
-Develop internal expertise and Standard Practices
-Medicare Overview, 855 submission and when enrollment goes wrong
This SMMC provider webinar talks about specialty plans involved in the SMMC program. These plans are designed to provide services tailored for individuals with a particular diagnosis, such at HIV/AIDS, Mental Illness, CHF, COPD, or Diabetes.
This presentation is designed to provide an overview of the choice counseling process and how it can benefit long-term care recipients in the State of Florida.
This presentation outlines the specific requirements for Hospice providers with respect to the Statewide Medicaid Managed Care (SMMC) Long-term Care program in Florida.
This presentation covers protections afforded to enrollees and providers participating in the Long-term Care aspect of Florida's Statewide Medicaid Managed Care program.
This presentation shows providers how to verify a patient's Medicaid eligibility before providing services to them as part of the Managed Medical Assistance program.
This webinar defines the "Medicaid Pending" status and serves to educate providers on the needs of individuals in this situation as it relates to the SMMC Long-term Care Program.
This provider webinar has been customized to inform hospice providers about how they can participate in the Statewide Medicaid Managed Care Managed Medical Assistance (MMA) program.
David Hopewell, Chief Product Officer at Transamerica, Aegon's U.S. Subsidiary, outlines the market potential for long-term care and its strategic fit in Transamerica's portfolio. Transamerica at AIFA Conference, March 7, 2017.
Improving patient referral management workflow between federally qualified he...GaryRichards30
A referral process may become inefficient and ineffective if the Federally Qualified Health Centers and the specialty clinics/imaging centers fail to communicate. When there is no proper communication from the specialty centers/imaging centers the community healthcare network finds it difficult to understand the progress of the referral. Let us see it from different perspectives to understand why there is a communication gap.
This webinar continues the COVID-19 Insights webinar series. Topics include the loans and grants being offered by the government, how they differ, and how they may benefit your practice, including SBA Loans and Grants, HHS Grants, Medicare Advance/Accelerated Payments, and Telehealth Funding. The webinar also goes over the CareOptimize technology developed to assist with streamlining COVID-19 monitoring and reporting.
6 reasons fqhcs and chcs benefit from patient referral management softwareGaryRichards30
FQHCs and CHCs provide critical primary care services to tens of millions of people each year in this country. Their role in the front-line of healthcare makes them important entry points for patients entering the broader healthcare system. Let us see how these organizations use patient referral management systems to leverage their role as an important source of patient referrals and improve the care they can provide for their populations.
FIDA Provider Training - Frequently Asked Questions (FAQs) | MetroPlusMetroPlus
Find out what the expectations and requirements are for providers to take the New York State FIDA Provider Training. Also find out answers to frequently asked questions regarding FIDA Provider Training. Visit http://www.metroplus.org/provider-services/fida-training-faqs for more questions and answers.
For more information on FIDA, please visit http://www.metroplus.org.
Figuring out telemedicine reimbursement can be tricky. The guidelines can vary based on your state, payer, and how you're using telemedicine. At eVisit, we're trying to demystify this process for physicians - so telemedicine makes it easier to increase your practice revenue!
Learn how telemedicine reimbursement works for Medicare, Medicaid, and Private payers - including specific CPT codes and tips for billing.
Telemedicine reimbursement can be tricky, to say the least. How do you ensure you get paid for live video medical visits via Medicare, Medicaid, and third-party payers? What kinds of guidelines do you need to follow?
In this SlideShare, all these questions are answered by billing consultant Adella Cordova, our resident expert on how telemedicine reimbursement works. While there are no guarantees in this shifting policy landscape, each of the main payers does has specific requirements and billing rules for delivering telemedicine.
You'll learn:
-Medicare's guidelines for telemedicine reimbursement
-How to research the Medicaid guidelines for telemedicine in your state
-Trends in billing for telemedicine through private payers
-Guidelines for coding and verifying telemedicine coverage
These slides were originally used in our webinar on telemedicine reimbursement. Request the free recording here: http://try.evisit.com/september-webinar-how-to-get-reimburse/?utm_source=Blog&utm_medium=post&utm_campaign=webinar
How valuable is a patient referral management software to primary care physic...GaryRichards30
When PCPs send a referral to a specialist, they expect that specialists will let them know when their patients received care. Many times it doesn’t happen as expected. The hospital may be too busy to share information. In other cases, the hospital may have faxed a notification to a patient’s primary care physician (PCP). But, for one reason or another like coordination issues, busy schedule, the physician practice may never have received it. There are many such problems as the above PCPs deal with every day
Since the launch of the Marketplaces and Medicaid expansion, one out of every 20 Americans has been added to the Medicaid roll. More than 51 million Americans receive physical health benefits from a private Medicaid health plan (or 70% of all beneficiaries) and as of Q3 2015, 41 states had some form of private managed Medicaid. Along with the rapid expansion of Medicaid, comes the push for managed care plans to adopt value-based care approaches that tie provider reimbursement to quality measures and better outcomes. This presentation gives physicians crucial details about Medicaid and CHIP Managed Care Proposed Rule CMS 2390-P, and the five factors for value-based payment success in the era of Managed Medicaid.”
Since the launch of the Marketplaces and Medicaid expansion, one out of every 20 Americans has been added to the Medicaid roll. More than 51 million Americans receive physical health benefits from a private Medicaid health plan (or 70% of all beneficiaries) and as of Q3 2015, 41 states had some form of private managed Medicaid. Along with the rapid expansion of Medicaid, comes the push for managed care plans to adopt value-based care approaches that tie provider reimbursement to quality measures and better outcomes. This presentation gives physicians crucial details about Medicaid and CHIP Managed Care Proposed Rule CMS 2390-P, and the five factors for value-based payment success in the era of Managed Medicaid.”
Physician Credentialing- Worth Getting Right to Get Paid.pptxalicecarlos1
Physician credentialing is the process of organizing and verifying the professional records that qualify a doctor to practice medicine.
Read More: https://bit.ly/3FYmQSW
Similar to SMMC Long-term Care Provider Webinar: Medicaid Provider Enrollment (20)
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
SMMC Long-term Care Provider Webinar: Medicaid Provider Enrollment
1. Welcome to the Agency for Health
Care Administration Training
Presentation for Potential
Long-term Care Providers.
The presentation will begin momentarily.
Please dial in ahead of time to:
1-888-670-3525
Passcode: 771 963 1696
2. Statewide Medicaid Managed Care
(SMMC)
Long-term Care Program
Medicaid Provider Enrollment
April 17, 2013
3. 1. Follow the link below to
the SMMC Website
2. Select the “News and
Events” tab under the
header image.
Note: You can also use the
red button to sign up for
SMMC Program updates via
e-mail.
http://ahca.myflorida.com/Medicaid/statewide_mc/
3
4. 3. Select “Event Materials”
to download today’s
presentation.
Note: You may also view
details regarding future
SMMC events using the
“Upcoming Events” tab.
4
5. 4. Choose the file(s) you
would like to save.
Note: You may also view
files from past events and
AHCA guidance statements
or submit questions to be
answered in future
presentations.
5
6. Today’s Presenter
• Shawn McCauley
– Medicaid Contract Management Administrator
– Agency for Health Care Administration
6
7. Learning Objectives
• Increase knowledge and understanding of the
Provider Enrollment processes
– Enrolling a provider for a fee-for-service (FFS)
Medicaid Provider Service Network (PSN)
– Registering a provider for a capitated Medicaid
MCO
7
9. Provider Requirements
• To submit fee-for-service claims under a FFS
PSN, a provider must be actively enrolled in
Medicaid.
• To submit encounter data under a capitated MCO,
a provider must be either actively enrolled in
Medicaid or be registered with Medicaid.
• All providers must meet all provider requirements
at the time the service is rendered.
9
10. Enrollment Qualifications
• Applicants must meet all the provider
requirements, qualifications and their practices,
business, or facility must be fully operational
before they can be actively enrolled as Medicaid
providers.
• Specific qualifications for each provider type are
located in the Provider General Handbook and
the service-specific Coverage and Limitations
Handbooks. PDFs may be downloaded from
www.mymedicaid-florida.com
10
11. Ongoing Eligibility
• Providers must continue to meet all the provider
qualifications to remain enrolled in Medicaid.
• Medicaid will terminate any provider’s
enrollment who no longer meets any of the
provider qualifications.
• If a provider continues to receive payment for
services rendered after no longer meeting the
provider qualifications, the payments will be
subject to recoupment; and, if applicable, the
provider will be referred to the Attorney General,
Medicaid Fraud Control Unit.
11
12. Accuracy of Information
• All enrollment statements or documents
submitted to the Agency for Health Care
Administration (AHCA) or the Medicaid fiscal
agent by the provider must be true and
accurate.
• Filing of false information is sufficient cause
for denial of an enrollment application or
termination from Medicaid participation.
12
13. Non-Institutional Provider List
Medicaid defines non-institutional providers as the following provider types:
Advanced Registered Federally Qualified Prescribed Pediatric
Nurse Practitioner Health Center Extended Care Center
Air Ambulance Freestanding Dialysis (PPECC)
Ambulance Center Registered Nurse
Audiologist Hearing Aid Specialist Registered Nurse First
Billing Agent Home and Community- Assistants
Birth Center Based Services Rural Health Clinic
Case Management Home Health Agency Therapeutic Services for
Agency Independent Laboratory Children
Case Manager/Social Licensed Midwife Therapist
Worker Medical Assistant Transportation Non-
Chiropractor Medical Foster Care or Profit
Community Mental Personal Care Transportation Multi-
Health Center Optician load Private
County Health Optometrist Transportation-Non-
Department Emergency
Pharmacy Transportation-Private
Dentist Physician Assistant
Durable Medical Physician M.D. & D.O.
Equipment Podiatrist
Professional Early Portable X-ray
Intervention
13
14. Institutional Provider List
Medicaid defines institutional providers as the following provider types:
• Adult Family Care Homes (AFCH)
• Ambulatory Surgical Centers (ASC)
• Assisted Living Facilities (ALF)
• Hospices
• Hospitals
• Hospital-Based Skilled Nursing Units
• Intermediate Care Facilities for the Developmentally Disabled
(ICF/DD)
• Residential Treatment Facilities (RTF)
• Skilled Nursing Facilities
• State Mental Hospitals
• Statewide Inpatient Psychiatric Program (SIPP) Providers
• Swing Beds
16. Medicaid Web Portal
• Florida Medicaid's Web Portal provides
communication, data exchange, and self-service tools
to the provider community.
• The Web Portal consists of both public and secure
areas.
• Go to http://www.mymedicaid-florida.com
16
18. Public Web Portal
The public area contains:
– General information, such as program awareness,
notices, and forms.
– Specific information such as provider handbooks,
provider alerts, fee schedules, training, companion
guides as well as contact information for the
Medicaid fiscal agent and the Medicaid Area
Offices.
19. Public Web Portal
– For Coverage and Limitations Handbooks
• Click Provider Support, then Provider Handbooks.
Scroll down to the handbooks you need.
20. Public Web Portal
– For Enrollment Wizard
• To apply online, click Enrollment, scroll down to ON-
LINE ENROLLMENT WIZARD, click and follow the
online instructions.
21. Public Web Portal
– For Additional Enrollment forms
• Click Enrollment, then Enrollment Forms. Scroll down
to the forms you need - This is where FFS applicants
obtain the EFT and EDI forms.
23. Secure Web Portal
• Enrolled FFS providers are assigned a
Medicaid ID and a Personal Identification
Number (PIN) with which they may access the
secure portal.
• Online training is available for all features of
the secure portal.
24. Secure Web Portal
Providers may:
– Update basic information;
– Download a form to update address information;
– Verify recipient eligibility;
– Request and track prior authorization and referrals;
– Submit and track claims and Explanation of
Benefits (EOB) responses;
– Access provider alerts, notices and policy updates;
– View group relationships.
24
26. Section 3
Enrolling Providers for a
Fee-for-service Medicaid
Provider Service Network
26
27. Fee-for-service (FFS) Enrollment
• Providers who contract with a FFS Provider
Service Network (PSN) must be fully-enrolled
in Florida Medicaid.
• Providers who are currently enrolled simply
share their Medicaid ID and NPI data with the
PSN.
• Providers who are not enrolled will submit a
Florida Medicaid Provider Enrollment
Application.
27
28. FFS Enrollment
To enroll in Medicaid, FFS applicants must submit the following forms and
documentation:
• Online Florida Medicaid Provider Enrollment Application
• Medicaid Provider Agreement
• Electronic Data Interchange Agreement
• Electronic Funds Transfer with Account Verification
• Voided check/deposit slip or a bank letter verifying the account name,
the account number, and the transfer/routing number.
• Proof of Tax ID
• Social Security Number - Submit copy of Social Security card
• Federal Employer Identification Number (FEIN) - Submit proof of
FEIN from the IRS showing name and tax ID or an IRS Form W-9
with an original signature.
• Copies of applicable licenses.
• Any other information that is required by the Enrollment Wizard such as
copies of certifications, local business licenses, and other required
documentation.
29. Background Screening
• Level 2 background screening is required
for all persons declared on the application.
• Medicaid utilizes LiveScan vendors
throughout the state to submit fingerprints.
• Complete instructions regarding
background screening are posted on the
public portal under
Enrollment/Background Screening.
30. Background Screening
• Please have the following information available at the time of screening:
– A valid picture ID
– Full Name
– Address
– Social Security Number
– Date of Birth
– Race
– Sex
– Height
– Weight
• Tell the LiveScan vendor your screening is for Florida Medicaid Provider
Enrollment and should be submitted under ORI FL922013Z. This ensures
the results are delivered to Florida Medicaid.
• Florida Medicaid may not share results with the applicant or an employer at
this time. A future enhancement will allow sharing.
31. Fee-for-Service (FFS) Enrollment
• FFS applicants are encouraged to use the On-
line Enrollment Wizard which includes:
– Step-by-step instructions
– Start and stop feature
– Validation that all required sections are complete
before submission
– No postage fees - Upload or fax the supporting
documents
– Tracking of submitted application status
32. Enrollment Wizard Timeouts
Users with Internet Explorer 7 and Internet Explorer 8 may
experience timeout messages when accessing the wizard.
Solutions:
– Upgrade to Internet Explorer 9; or,
– Start your provider application from the following
address for the Medicaid Public Web:
https://portal.flmmis.com/flpublic/Provider_Enrollment
_EnrollmentApplication/tabid/54/desktopdefault/+/Defa
ult.aspx.
32
35. Enrollment Wizard
• Once enough data is entered to save the application the wizard
assigns a tracking number (ATN). Use the ATN and the name
to track the status of the application on the portal.
36. Enrollment Wizard
• The wizard only asks for information
necessary for your specific provider type and
specialty.
• The wizard ensures each question is answered
before proceeding.
• Remember, once you receive your ATN, you
may exit and return later to complete the
application.
37. For More Information
• If you have questions:
– Review the Guide for Completing a Medicaid
Provider Enrollment Application on the Medicaid
public portal, or
– Call the Medicaid Provider Enrollment Unit at
1-800-289-7799, Option 4.
38. Enrollment Wizard
After submission, the Wizard
generates a list of required
supporting documents.
They may be uploaded directly
from this screen or faxed in.
Applicants may print a copy of
their application for their
records.
40. Capitated Registration
• Providers who contract with a capitated
Managed Care Organization (MCO) must have
a Florida Medicaid ID which will be used for
the submission of encounter claims data.
• Providers who are enrolled in Medicaid for
FFS simply supply their Medicaid ID and NPI
data to the MCO.
40
41. Capitated Registration
• Providers who do not have a Medicaid ID may
obtain one through a simplified registration
process.
• The MCO submits on behalf of the provider
through one of two methods:
– Automated Mass Registration Tool; or,
– Simplified Registration Form.
41
42. Mass Registration
• MCOs may submit provider mass registration files to register in-state
providers that are members of the MCO provider network but who are
currently not enrolled or registered as an active Florida Medicaid
provider.
• The Mass Registration tool:
– Validates the data file for format and content
– Matches against the existing provider database to ensure there is no
duplication of provider records.
• If the record does not match an existing record, a new provider
ID is added.
• If the record matches an existing record, a new provider ID is
not added.
– Reports back to the plan
42
43. Mass Registration
• The Mass Registration and Linking/Delinking
Guide is available on the Managed Care page
of the public Web portal.
• Assistance with technical questions about the
Mass Registration is available from HP EDI
Helpdesk at 866-586-0961.
43
44. Mass Registration
Common Errors
• Missing or Invalid Data
– License Number
– Street Address
– Tax ID
• Duplicate Requests for the same provider
45. Manual Registration
Managed Care Treating Provider Registration
Providers who are not already enrolled with the Florida Medicaid program, and who perform services for Florida
Medicaid eligible recipients under a Medicaid capitated managed care organization (MCO), may submit this form to
obtain a Florida Medicaid provider ID. The provider ID may then be used to submit encounter data for the services
rendered under the MCO. The provider may also be available as an option for assignments in the choice counseling
process.
• Applicants who do not sign this form will not be available as an option for assignments in the choice
counseling process. An MCO may submit the form on their behalf and a provider ID will be assigned solely
for the submission of encounter data.
• This form may not be used to apply as a fee-for-service provider. If the applicant plans to submit claims
directly to Florida Medicaid for fee-for-service reimbursement, they must submit the full Florida Medicaid
Provider Enrollment Application, available at http://mymedicaid-florida.com.
1. Provider Name
Enter the applicant’s name and, if applicable, a Doing Business As (D/B/A) designation.
Last Name or Business Name:
First Name:
Middle Name or Initial:
Doing Business As:
(Optional)
2. Tax Information
Check the appropriate box to indicate a Social Security Number (SSN) or Federal Employer Identification Number (FEIN)
and list the nine (9) digit number.
Social Security Number Federal Employer Identifier Number
3. Address Information
NOTE: The Service Location Address must be a physical location, not a Post Office box or mail service center.
Service Location Address:
Building, Suite Number:
City: State: ZIP:
County:
Telephone Number: ( )
Area Code
46. Manual Registration
• Out-of-State providers download, complete and submit the
“Managed Care Treating Provider Registration” form to the
MCO. The form may be scanned and delivered electronically.
• The MCO signs the form and forwards to Medicaid for
processing.
• Medicaid sends a welcome letter to the provider. The letter
contains the new Medicaid ID and the MCO to which the
provider is linked.
• An MCO may submit the registration form on behalf of out-of-
state providers.
• If the MCO submits the form on behalf of the provider, Medicaid
sends the welcome letter to the MCO, not to the provider.
47. Manual Registration
• The Managed Care Treating Provider
Registration form is available on the Managed
Care page of the public Web portal.
• The registration form may not be used to apply
as a fee-for-service provider. (See FFS
Enrollment.)
47
50. Resources
• Contact information for the Medicaid fiscal
agent, the Medicaid Area Offices, and the
Medicaid field representatives is located on the
public portal.
50
51. Resources
Questions can be emailed to:
FLMedicaidManagedCare@ahca.
myflorida.com
Updates about the Statewide
Medicaid Managed Care program
are posted at:
http://ahca.myflorida.com/Medicaid
/statewide_mc
Upcoming events and news can be
found on the “News and Events” tab.
You may sign up for our mailing list by
clicking the red “Sign Up for Program
Updates” box on the right hand side of
the page.
51