Find answers to the most frequently asked questions here.
General
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Billing General
National Provider ID (NPI)
Correct Coding Initiative (CCI)
Electronic Data Interchange (EDI)
Web Portal
Automated Voice Response System (AVRS)
Provider Enrollment
Provider Field Services
1. What are the telephone numbers to reach the fiscal agent?
Return
2. What are my options for receiving a Remittance Advice (RA)?
Three options for receiving an RA include:
3. Is there a charge for reprinting a paper Remittance Advice (RA)?
Yes. There is a charge of $.50 per page to print a paper RA. Make the request by calling the Provider Services Contact Center at 1-800-289-7799 (Option 7).
4. What are my options for determining a recipient's eligibility?
Providers with a valid provider number can use any of the following:
5. Where can I obtain an Ad Hoc Report Request form?
6. Who do I call if I have secure Web Portal PIN related questions?
Please call the Provider Services Contact Center at 1-800-289-7799 (Option 5).
7. Where can I obtain a list of Internal Control Number (ICN) region codes?
A document detailing the ICN region codes is available here.
8. Where can I obtain a copy of the agenda for the Florida Hospital Association (FHA) meeting?
The agenda for the FHA meeting is available here (updated as required).
9. Where can I obtain support materials for the Hospice Claims Workgroup meeting?
The following support materials are available for the Hospice Claims Workgroup meeting:
10. Where can I obtain a list of common KePro error codes?
A document providing a list of the most common KePro error codes is available here.
1. What are my options for claim submission?
The four main options for claim submission include:
2. What are my options for addressing claim denials?
In cases where the denial can be corrected, claims may be resubmitted via the Web Portal for real-time processing, or through each of the standard claim submission options (e.g., paper, EDI, or PES).
3. Where do I address questions regarding billing?
Providers have a number of resources available to assist them. These include:
4. How often are payments made?
Payments are made weekly, based on the claims submitted during the processing week.
5. How should I correctly bill for Magellan Medicaid Administration authorized claims that are denying for 3049 due to the counting of the discharge date?
If the last day on the statement coverage period is not within the prior authorized time span, C3 condition code and M0 (zero) occurrence code combination should be used when billing. Please refer to the UB-04 Reimbursement Handbook for full instructions.
6. Please note the following requirements for an outpatient claim for recipients with Alien eligibility:
The system will assess the claim initially for certain criteria, and the claim may pay or deny (regardless of whether attachments are present). Specifically, the claim must be: 1) billed by hospital providers on the UB-04 claim, with type of bill 131, 2) Admission type is "1" (Emergency) or "5" (Trauma), and 3) one of the revenue codes is 450. There are criteria related to dialysis and delivery services that are also considered.
7. When will Error 6 and Error 10 post on Prior Authorizations (PAs)?
Error 6 will post when the recipient is not eligible (on the first requested day of the date span). Error 10 will post when there is a duplicate PA (for all or a portion of the date span requested). Error 10 will not post if the overlap is one day and only matches either the admit or discharge date of another authorized PA.
8. Why is my concurrent mother/baby stays now denying for EOB 0317: Units billed on revenue codes 100 - 219 do not match covered date spans?
As of 10/21/10, a system implementation has set EOB 0317 to deny on any claim that does not contain an admit type of "4" (newborn) and contains a mismatch of units. Medicaid Services confirms "for mom/baby claims, hospitals are to always bill with an admit type of ‘4’ in order to trigger the concurrent days in the system."
9. Where can I find downloadable handbooks in the Web Portal? How can I order a hardcopy version of the handbooks?
The Medicaid Handbooks are available for download in the Web Portal here. You can use the Handbook Order Form available at the bottom of the Handbooks page to order handbooks.
1. When do I have to begin submitting NPI on my claims?
As of January 1, 2011, Medicaid requires that all providers who must obtain an NPI include their NPI on all claims submitted to Medicaid. This will include all claims from these providers, whether submitted on paper or electronically. The Medicaid provider number will be allowed to accompany the NPI on claims; however, claims that do not contain the NPI will be denied. Providers who are required to obtain an NPI and have not registered their NPI number with Florida Medicaid can fill out the National Provider Identifier Registration Form and fax it to Medicaid Provider Enrollment at 866-270-1497 or mail it to the following address: HP Provider Enrollment PO Box 7070 Tallahassee, FL 32314-7070 The X12 transactions mandated by HIPAA are being modified with a new version, known as 5010. As Florida prepares to convert electronic transactions to the new version of HIPAA, further changes in the electronic claims are needed for the use of NPI for providers who must obtain an NPI. The 5010 version of the claims transactions will no longer allow providers to include the Medicaid provider number as part of the transaction and will allow only the NPI. This affects only electronic claims. Consequently, in preparation for the 5010 implementation, Florida Medicaid will no longer accept X12 claim transactions that contain the Florida Medicaid provider number starting in May 2011. Electronic claims that contain the Medicaid provider number will be denied. Florida Medicaid will provide further instructions in the near future on the 5010 implementation and associated changes that will be required later in 2011. Related Provider Notices
2. Why do I have to bill an NPI and taxonomy number?
Florida Medicaid providers with multiple Medicaid IDs are required to use the taxonomy and, in some cases either the ZIP or the ZIP + 4, to create a unique match of each of their Medicaid IDs to their NPI. If the taxonomy or ZIP or ZIP + 4 are used to create this match, these elements become required data in the billing, pay-to and treating provider loops on an X12 claim transaction.
3. What is a taxonomy number?
The Healthcare Provider Taxonomy code set divides health care providers into hierarchical groupings by type, classification, and specialization, and assigns a code to each grouping. The Taxonomy consists of two parts: individuals (e.g., physicians) and non-individuals (e.g., ambulatory health care facilities). All codes are alphanumeric and are 10 positions in length. These codes are not “assigned” to health care providers; rather, health care providers select the taxonomy code(s) that most closely represents their education, license, or certification. If a health care provider has more than one taxonomy code associated with it, a health plan may prefer that the health care provider use one over another when submitting claims for certain services. (Source: http://questions.cms.hhs.gov)
4. How do I send/update my NPI and/or taxonomy information?
Providers can send/update NPI information using the National Provider Identifier Registration Form and faxing it to Medicaid Provider Enrollment at 866-270-1497 or mailing it to the following address: HP Provider Enrollment PO Box 7070 Tallahassee, FL 32314-7070
5. How does AHCA determine the service location for processing claims and payment when I bill with the NPI?
If a provider has only one Medicaid ID, the NPI alone will match to the correct Medicaid ID for processing the claim. Providers with multiple Medicaid IDs are required to use the taxonomy and, in some cases either the ZIP or the ZIP + 4, to create a unique match of each of their Medicaid IDs to their NPI. If the taxonomy or ZIP or ZIP + 4 are used to create this match, these elements become required data in the billing, pay-to and treating provider loops on an X12 claim transaction in order for the claim to process correctly.
6. Is there a timeline?
Yes. The following is the Florida Medicaid timeline for NPI and 5010 implementation: Timeline for NPI: January 1, 2011
1. What is CCI?
The CCI is a software program developed by the Centers for Medicare and Medicaid Services (CMS) to promote correct coding and increase physician awareness of correct coding guidelines. The CCI program reviews Health Care Procedure Codes (HCPCS) against set standards to determine if a code(s) billed by a provider is part of a more comprehensive code or mutually exclusive of another code for the same provider, and the same recipient, on the same date of service.
2. What is the effective date of CCI implementation?
October 1, 2010.
3. How many modifiers will the system accept?
The system will accept up to 2 modifiers.
4. Will CCI be using the same code tables as those already published for Medicare by CMS?
CMS has provided a separate, unique set of codes for the Medicaid program. CMS will provide quarterly updates to the State. More information can be found here.
5. What types of claims will be affected by CCI?
Only Professional, Dental and Outpatient claims will be affected. CCI will not be applied to COBA-submitted Medicare Crossover claims, as the COBA processer would have already applied NCCI editing.
6. Can providers submit test claims to evaluate how the claims will be adjudicated?
The changes will be effective October 1, 2010. Providers will be able to evaluate the effect of CCI on claims submitted after this date.
1. Where can I access the Florida Companion Guides for billing electronically?
The Companion Guides can be found by selecting EDI > Companion Guides from the menu to the left.
2. Does HP accept images of hard-copy attachments to facilitate claim submission through electronic options?
Yes, a claim can be submitted electronically, and an image of a hard-copy attachment, when required, uploaded via the secure Web Portal or faxed to HP. For more information regarding this functionality, please see the Web Portal User Guide, available by selecting Provider Support > Provider Handbooks from the menu to the left.
3. What parameters should be used when defining the Attachment Control Number (ACN) when sending attachments to claim?
The Attachment Control Number (ACN) should only include upper case letters and/or numbers, and should not include special characters or spaces. If these characters are included, the documentation will not match to the claims, and the claims will deny for attachments not received.
4. Are there any special requirements or processes for submitting hard-copy attachments for multiple claims?
To submit hard-copy attachments for multiple claims, it is imperative that the fax submission (if faxing the attachment) only include documents associated with a single claim. Each fax transmission creates only one image. If multiple attachments are sent in a single fax transmission, all documents will append to the first claim, and all other claims will continue to show that attachments have not been received. Additionally, the fax coversheet that is produced by the Web Portal should be the first page of all fax transmissions. Proprietary coversheets slow the process and should not be used. If you do not have access to the coversheet created by the Web Portal, please include a coversheet that contains only the following three index items: provider number, recipient number, and Attachment Control Number (ACN).
1. Can I submit claims directly on the Web?
Yes, the system provides functionality to support real-time claim processing via the Web Portal.
2. Can a claim be adjusted or voided on the Web?
Yes, a paid claim may be adjusted using the secure Web Portal and the interactive online claim functionality.
3. How long does it take for a claim to process when submitted on the Web through direct data entry?
Claims submitted on the Web Portal through Direct Data Entry (DDE) typically process in a real-time manner. This means that once the claim is submitted (using the "submit" button on the Web page), the claim is immediately processed in the Medicaid system (FMMIS) and a response indicating payment/amount paid or denial/denial explanation is provided.
4. Are historical Remittance Advices (RAs) available in the Web Portal?
Yes. Providers can access three months of RA history on the secure Web Portal.
5. If I bill for numerous providers, do I have to log in to each provider's number in order to access the secure Web Portal features?
A user can be authorized to view multiple provider's data. In order to enable this functionality, each provider must authorize the selected "user" to view their data. Once authorized, the selected user will be able to log in once and select which provider's data they want to access.
6. What security is in place on the secure Web Portal, and what is the process for setting up a user account? What roles can be assigned in the Web Portal?
The Florida Medicaid Management Information System (FMMIS) manages most Electronic Data Interchange (EDI) services on a secure Web Portal. Each provider (to include trading partners) is issued a Personal Identification Number (PIN) letter. Using the PIN letter, providers can set up a secure Web Portal account for each provider number (for example, service location). Once an account is set up, the provider can authorize/designate other “agents” to access their X12 835 transactions. The term “agent” is used generically within the secure Web Portal to identify a person or organization’s representative for whom a secure Web Portal account has been created. Providers can authorize representatives (or agents) within their organization or outside of their organization to access their information or act on their behalf. For agents outside of the provider’s organization (for example, a trading partner), the provider adds the agent through a brief authorization process on the secure Web Portal. The authorization process uses a role based security function to facilitate adding only the desired access. For example, a provider can authorize an agent to retrieve their 835 transaction ONLY while restricting the agent from submitting claim transactions. Please note that Florida Medicaid policy has not changed regarding billing agents. Billing agents are required to enroll as Florida Medicaid providers in order to submit claims. For more information in setting up an account and adding agents, please see the Web Portal User Guide, available by selecting Provider Support > Provider Handbooks from the menu to the left.
7. What do providers or authorized trading partners need to do to be able to access the Web Portal?
Providers and trading partners should create their secure Web Portal account using the Personal Identification Number (PIN) letters they received in the mail. Once created, providers that wish to provide another trading partner access to their X12 835 transactions must authorize the trading partner’s agent account as described earlier. For more information in setting up an account, please see the Web Portal User Guide, available by selecting Provider Support > Provider Handbooks from the menu to the left.
8. Where do I enter my MediPass referral number when submitting a claim via the Web Portal?
When billing a claim using the secure Web Portal that requires a MediPass referral, the MediPass referral number should be entered in the Referring Physician field.
9. Where do I enter my Service Authorization (SA) number when submitting a claim via the Web Portal?
When billing a claim using the secure Web Portal that requires an SA number, the SA number should be entered in the Referring Physician field.
10. When performing eligibility verification on the Web Portal, what does it mean if a response includes references that state “limited to family planning benefit?"
That statement is referring to the Family Planning benefit. As a reminder, in cases where a recipient has eligibility in multiple benefit plans, with one of the plans having a higher level of benefits (for example, Full Medicaid), the Full Medicaid plan takes precedence and more fully represents the recipient's eligibility.
11. How do you pull an existing claim in the Web Portal to process an adjustment or void?
To pull an existing claim in the Web Portal, go to the Claims menu and select the Search submenu. From the Search page, you can enter the claim’s Internal Control Number (ICN) in the ICN/TCN/HSID field, leaving all of the other fields blank, and click the Search button in the right hand corner. If you have only the Recipient ID, then you must enter the Recipient ID, the Claim Type, and the Date of Service for the claim. In the Date of Service field, select Date Range and enter the specific dates that you are searching. All of the criteria must be completed before performing your search. Then click the Search button, and a search results list will be returned with several claim options that were billed with the date of service request.
1. Do I need a password to log in to the automated voice response system?
No, a password is not required. A valid provider number is required.
2. On the automated voice response system, can I check eligibility with a Social Security Number (SSN)?
Yes. When checking eligibility using the recipient's SSN, the date of birth is also required.
1. Is there an option to submit Provider Enrollment applications on the Web?
Yes, an interactive Enrollment Wizard will assist providers wishing to enroll in the Florida Medicaid program. Potential providers will also be able to upload attachments as may be required when enrolling. Original signatures will continue to be required for certain documents. Thus, some limited information may need to be mailed to the Provider Enrollment Unit.
1. How do I request a visit from a Field Representative?
You may contact the local Medicaid area office or the Provider Services Contact Center, at 1-800-289-7799 (Option 7) to request a visit.