Providers must renew their Medicaid Provider Agreement and complete a Provider Re-Enrollment form to continue participation in the Title XIX Medicaid Program. Per Florida Statute 409.907, the agency may make payments for medical assistance and related services rendered to Medicaid recipients only to an individual or entity who has a provider agreement in effect with the agency.
Providers will receive a reenrollment letter and pre-printed packet approximately 90 days before the expiration date of the provider agreement associated with their Medicaid ID. The packet must be reviewed for accuracy and completed. Additional documentation required must be faxed or mailed. Those providers with more than one service location will receive notification for the base ID and will not need to reenroll each individual service location separately.
Please note that the Florida Medicaid Provider Reenrollment Guide should be reviewed to ensure accuracy of submission of required documents.
Provider Enrollment is available to assist providers with enrollment issues such as change of address, change of ownership or other reenrollment issues. Phone: 1-800-289-7799, Option 4. Providers must fax or mail the completed packet within 30 days. The fax number for Provider Reenrollment is 866-270-1497. Faxed documents must have a cover sheet (Fax Cover sheet can be obtained from the Provider Web Portal). Completed packets may be mailed to:
For Regular Mail HP Enterprise Services Provider Reenrollment PO Box 13800 Tallahassee, FL 32317-3800
For Overnight or Express Delivery HP Enterprise Services Provider Reenrollment 2671 W Executive Center Cir Ste 100 Tallahassee, FL 32301-5020
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Provider Re-Enrollment Forms
Additional Re-Enrollment Forms Some provider types may need to submit additional forms at the time of re-enrollment.