The intent of the Medicaid handbooks is to furnish the Medicaid provider with policies and procedures needed to receive reimbursement for covered services provided to eligible Florida Medicaid recipients. The handbooks provide detailed descriptions and instructions on how and when to complete forms, letters, or other documentation. There are two sets of provider handbooks for each provider type. The Coverage and Limitations Handbooks explains covered services and policies for each type of Medicaid Service. The Reimbursement Handbooks contain generic eligibility information, general Medicaid information, and claim instructions. There is also a Medicaid Provider General Handbook.

The Web Portal User Guide is also available and provides information on registering your account, as well as, understanding page layout and how to navigate within the Web Portal. The Web Portal User Guide also provides instructions on how to complete and submit a claim using the Web Portal.

Correction to UB-04 Claim Form

Please use the following Type of Bill codes for Skilled Nursing Facility and Intermediate Care Facility billing instead of the codes listed in the Advance Draft of the UB-04 handbook. The UB-04 is being updated to correct the codes.

Using any other Type of Bill code for Long Term Care electronic billing directly to Florida Medicaid will result in denied claims and potentially incorrect payments.

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Handbook Requests

EDS supplies one handbook set (which includes the Provider General Handbook, provider specific Coverage and Limitation Handbooks, Reimbursement Handbooks, and appropriate fee schedules) and all subsequent updates free of charge to each individual practice provider and one copy to each active provider group. If a provider cannot or chooses not to download the handbooks from the Internet, additional hardcopy or CD request of handbook sets and updates cost $10.00.

If a non-provider cannot or chooses not to download handbooks from the Internet, there is a charge of $10.00 for every handbook set requested. Non-providers receive the most up-to-date handbooks that are available on the day the handbooks are requested. This charge, however, does not include subsequent updates.

A Handbook Order Form will be mailed or faxed upon request. Fill out the form, and return the invoice along with a check payable to EDS for the correct amount ($10.00 x the number of handbooks requested).

EDS does not accept money orders, purchase orders, or credit cards for handbook orders. EDS cannot give change if the check amount is incorrect; incorrect checks will be returned to the provider.

If you want the handbook sent via FedEx, or other express delivery, you must provide an account number or make other arrangements to pay for the overnight delivery. Please call the Provider Support Contact Center at 800-289-7799 Option 7, or click the link to obtain a Handbook Order Form.

Summary of Services

The Florida Medicaid Summary of Services booklet is intended to be a quick reference to Medicaid services. This summary provides an overview of Florida Medicaid services as well as information on Medicaid eligibility and managed care programs.

It is intended as an introduction to Medicaid for new Medicaid employees and for staff working in other programs, agencies, and departments.

Users who do not work in state government may want to contact their local Area Medicaid Office for more details about covered services.

Everyone should refer to the Florida Medicaid Provider General Handbook or the service-specific Coverage and Limitations and Reimbursement Handbooks for more detailed information about Florida Medicaid.