Provider Enrollment is responsible for enrolling qualified providers to receive Medicaid reimbursement for services rendered to Medicaid Fee-For-Service recipients.
Provider Support provides research and technical support for Medicaid Fee-For-Service claims inquiries and processing issue resolution. For assistance contact 1-877-254-1055.
Exceptions to the 12-month claim submission time limit may be allowed, if the claim meets certain conditions.
Children’s Medical Services Plan Eligibility
Effective Monday, January 11, 2016, a new Florida Department of Health rule was enacted to 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 CMS.ClinicalEligibilityScreening@flhealth.gov or via fax to 850-488-3813. Please be sure to submit all five pages of the attestation.
If physicians have questions about the CMS Clinical Eligibility Attestation, please contact a CMS plan nurse at 850-245-4444, extension 3291.
Florida Medicaid contracts with a Fiscal Agent for provider enrollment, management of the beneficiary file/records Medicaid Fee-For-Service claims processing and payment.
Florida Medicaid contracts with the following entity to perform Prior Authorization/Utilization Management services.