Find answers to the most frequently asked questions here.
General
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Billing General
National Provider ID (NPI)
Electronic Data Interchange (EDI)
Web Portal
Automated Voice Response System (AVRS)
Provider Enrollment
Provider Field Services
1. With the implementation of a new system, will I have to re-enroll?
No. Providers will not be required to submit any new documentation related to the implementation of the new system.
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2. What are the telephone numbers or addresses I should use to submit claims or other claim-related documents?
There are three numbers for contacting EDS:
3. What are my options for receiving a remittance advice?
There are 3 options for receiving a remittance advice (formerly referred to as remittance voucher):
4. Will we receive a paper remittance advice?
Providers are encouraged to take advantage of non-paper options, including downloading a copy of their remittance advice (formerly remittance voucher) via the Web Portal or receiving an 835 transaction detailing their claim activities. A paper remittance advice will be available for providers that do not choose to access their remittance online.
5. Is there a charge for printing paper Remittance Advices (RAs)?
Yes. There is a charge of $.50 per page to print paper RAs.
6. What are my options for determining a recipient's eligibility?
Providers with a valid provider number can use:
7. Where can I obtain an Ad Hoc Report Request form?
8. Who do I contact if I didn't receive a PIN letter?
Please call the Provider Services Contact Center at 1-800-289-7799 Option 5.
9. Where can I obtain a list of Internal Control Number (ICN) region codes?
A document detailing the ICN region codes is available here.
10. Where can I obtain a copy of the agenda for the November 12 Florida Hospital Association (FHA) meeting?
The agenda for the November 12 FHA meeting is available here.
1. What are my options for claim submission?
There are four main options for claim submission:
2. What claim form should I use for billing?
Certain providers will begin billing with a new claim form. Training materials regarding the new paper claim forms can be found under Provider Support à Training in the menu at the left.
3. 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).
4. Where do I address questions regarding billing?
Providers have a number of resources available to assist them:
5. How often are payments made?
Payments are made weekly, based on the claims submitted during the processing week.
1. When do I have to begin submitting NPI on my claims?
Providers should submit all claims with an NPI number. Providers that do not yet have an NPI number can fill out the National Provider Identifier Registration Form found by selecting Provider Support --> Enrollment from the menu to the left and mailing it to the following address: EDS Provider Enrollment PO Box 7070 Tallahassee, FL 32314-7070
2. Why do I have to bill an NPI and Taxonomy Number?
The NPI provides no indication of service location. The Medicaid system must process transactions under the appropriate NPI and service location. The system uses certain data elements to identify the appropriate service location. NPI, taxonomy and 'zip code + 4' are the data elements used to identify the service location and are thus required for claim transactions submitted with an NPI.
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?
Active Florida Medicaid providers enrolled prior to May 8, 2007 can use the website https://floridamedicaidnpi.com/NPIFAQ.aspx to register their NPI with Florida Medicaid and to answer questions you might have about NPI and the registration process. Included on the Web site are frequently asked questions (FAQ). Providers enrolling on or after May 8, 2007 (including new Medicaid ID suffixes to existing base numbers), must register using the paper registration form found by selecting Provider Support --> Enrollment. The completed paper registration form should be mailed to the following address: EDS 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?
The system uses certain data elements to identify the appropriate service location. NPI, taxonomy and 'zip code + 4' are the data elements used to identify the service location and are thus required for claim transactions submitted with an NPI.
1. Are there new Companion Guides for billing electronically?
Yes. The Companion Guides can be found by selecting EDI --> Companion Guides from the menu to the left.
2. Can I still use WINASAP 2003? If not, why not?
No. This is a proprietary software provided by the previous fiscal agent (ACS). A replacement software, Provider Electronic Solutions (PES) is available at no charge. Providers may also bill using the Web Portal's Direct Data Entry (DDE) feature for real time claim submission and processing. For more information on PES, click EDI --> Software and Manuals
3. Does EDS 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 EDS. More information regarding this functionality is available in the Web Portal User Guide.
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 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.
1. Can I submit claims directly on the Web?
Yes, the system provides enhanced functionality to support real-time claim processing via the Web Portal.
2. Can a claim be adjusted or voided on th 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 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 FMMIS and a response indicating payment/amount paid or denial/denial explanation is provided.
4. Are historical remittance advice (formerly remittance vouchers) available in the Web Portal?
Yes. Providers can access 2 years of remittance advice history on the secure Web Portal.
5. If I bill for numerous providers, will I have to log in to each provider's number in order to access 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 new Florida Medicaid Management Information System (FMMIS) will manage most Electronic Data Interchange (EDI) services on a secure Web Portal. Each provider (to include trading partners) will be 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 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 835 transaction 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 number when submitting a claim via the Web Portal?
When billing a claim using the secure Web Portal that requires a Service Authorization, the Service Authorization number should be entered in the Referring Physician field.
Automated Voice Response System
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 an 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 Area Office or the Provider Services Contact Center, Option 7, and request a visit.