Important Information

System Messages

Holiday Office Closure
Florida Medicaid and HP offices, including the field offices and provider call center, will be closed Monday, May 25, 2015 in observance of Memorial Day. All offices will resume normal business hours on Tuesday, May 26, 2015.
Introducing the "New" Web Portal
Florida Medicaid and HP Enterprise Services are pleased to announce the redesigned Web Portal. In an effort to provide you with a more efficient and user-friendly experience when navigating the Web Portal, changes have been made to the landing page, navigation menus, and an expanded Managed Care section. Please review the Web Portal Redesign QRG to familiarize yourself with the changes.
Please review the Known Issues and Informational Items List (Updated 4/27/2015) for details related to the MMIS.
Upcoming Holiday Office Closure
Florida Medicaid and HP offices, including the area offices and provider call center, will be closed Monday, May 25, 2015, in observance of Memorial Day. All offices will resume normal business hours on Tuesday, May 25, 2015.
Please review the Holiday Office Closures document for a comprehensive list of 2015 scheduled holidays.
Please review the Scheduled Maintenance document for a comprehensive list of 2015 scheduled maintenance dates.

Current Topics

30 Day Notice for 999s
Florida Medicaid is implementing the X12 999 response acknowledgement file. The 999 reports the acceptance status of an inbound file and shows whether the inbound file is accepted, partially accepted, or rejected. The 999 reports the acceptance status of an inbound file and shows whether the inbound file is accepted, partially accepted, or rejected.

The 997 response acknowledgement file that is currently received by providers and Managed Care Organizations (Plans) when an inbound X12 transaction is transmitted will be replaced with the new 999 response acknowledgement file transactions effective June 19, 2015. This change only affects 270/271 and 276/277.

The 999 file can be downloaded from the Plan's secure Web Portal account by selecting the 999 document type from the Trade Files menu. For Plans utilizing SFTP connection, these files will show in the inbound folder.

Sample 999 files can be found on the Submission Information page on Florida Medicaid’s Public Web Portal.

For questions concerning the 999, please refer to the 999 Implementation Guide which can be purchased through the Washington Publishing Company or contact the EDI Helpdesk at 1-866-586-0961.
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Important Changes to Background Screening Requirements for Medicaid Providers
Effective March 2, 2015, new and renewing provider applicants for Florida Medicaid must access the Care Provider Background Screening Clearinghouse to initiate their background screenings.

Providers register in the Clearinghouse and are assigned secure accounts through which they access the Clearinghouse Results Portal. In the portal, they can confirm privacy policy, schedule background screenings with Livescan vendors, view screening results, and initiate agency review of prior screenings. Provider can create and maintain an employee roster of individuals screened through the Clearinghouse to assist with tracking multiple screenings.

NOTE: The Florida Medicaid Screening ORI Number and the fee for screening have changed.

The new ORI Number is EAHCA013Z. This ORI must be included in the transaction from the Livescan vendor in order for Florida Medicaid to receive results from the screening.

The new cost of the screening is $62.75 plus any handling fees charged by the Livescan vendor submitting the screening for the provider.
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FMMIS CAQH/CORE EOB-X12
The FMMIS CAQH/CORE EOB-X12 Adjustment Code Crosswalk has been updated to include Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC). The updated document contains highlighted changes and is available on the Submission Information page. ...more...less
Children's Medical Services Network (CMSN) Managed Medical Assistance (MMA) Notice
With the implementation of the CMSN managed care plan (MCP) on August 1, 2014, please note that Medicaid authorization, formulary, and claims requirements also apply to CMSN MMA plan.
CMS-1500 Version 02/12
A new CMS-1500 form will be required as of April 1, 2014. Florida Medicaid strongly advises providers to immediately transition to the new form, version 02/12, for all paper claims. The CMS-1500 claim form has been recently revised to more adequately support the use of the ICD-10 diagnosis code set. The revised CMS-1500 form, version 02/12, replaces the current form, version 08/05. For more information on the transition, please refer to the CMS-1500 Transition page in the Web Portal....more...less
System Enhancement for 835 Transactions
On March 14, 2014, a system enhancement will be implemented in the Florida Medicaid system to change how denials and monetary adjustments are reported on a claim that is reversed or adjusted by the provider. This change affects entities that receive the X12 835 transaction only.

Currently, for reversal transactions (Code 22), the service line detail is not being populated. The enhancement, when it goes into effect, will populate the reversed transaction’s detail information at the service line level. Please refer to the updated FMMIS 835 Health Care Claim Payment and Remittance Advice Companion Guide 005010X221A1 that references a new code value of "22" at CLP02.
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Upcoming Changes to 835 Code Reporting (CAQH/CORE Rule 360)
In our continuing efforts to maintain compliance with the federally mandated Council for Affordable Quality Healthcare/Committee on Operating Rules for Information Exchange (CAQH/CORE) rules, which are being implemented in accordance with the Affordable Care Act, Florida Medicaid has begun changes to how adjustments will be reported on the weekly 835 remittance advice files.

Per CAQH/CORE (Rule 360, section 1104), each payer is mandated to pull from a specific set of adjustment reason codes and remark codes. In compliance with this new rule, Florida Medicaid is issuing a new set of ARC/Remark Code combinations for claims reporting.

This code set will go live in the production database on 12/27/2013 and will appear on the 835 generated for the 1/3/2014 financial cycle.

To assist our providers and billing agents in preparing for this upcoming change, we have generated a list of these new code combinations that Florida Medicaid will be implementing and have posted it on the Submission Information page in the Florida Medicaid public Web Portal.

These changes will have no effect on the PDF version of the weekly remittance advice that is currently available on the secure Web Portal via the Reports menu.

More information on this federally mandated change is located on the official CAQH website.
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Claims Processing for Universal Health Care, Inc. Providers
Universal Health Care, Inc. (Universal) was ordered into receivership by the Second Judicial Circuit Court in Leon County, Florida, for purposes of liquidation effective April 1, 2013. The Florida Department of Financial Services, Division of Rehabilitation and Liquidation, is the court appointed Receiver of Universal.

REMINDER: Claims which were not paid as of the liquidation will be considered as claims against the Universal estate and subsequently processed by the Receiver during the liquidation process. Detailed information regarding the filing of claims in a liquidation proceeding is available on the Receiver's website, or by telephone at 1-800-882-3054. Please note that providers may not seek payment from Universal members for debt owed by Universal for medical services. Under Section 641.3154, Florida Statutes, HMO subscribers are not liable to any provider of health care services for any services covered by the HMO. Additionally, health care providers and their representatives are prohibited from attempting to collect payment from the HMO subscribers for such services.
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DRG-Related Changes to the 835 Report
As of Monday, July 29, 2013, the following fields will be visible on the 835 report:
  • IGT Payment Amount
  • DRG Base Payment Amount
  • Outlier Payment
  • Self-Funded IGT Payment
  • Maximum Policy Adjustor
Please refer to the 835 Companion Guide for additional detail information.
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Upcoming Access Changes
The Agency provides a number of services for Medicaid providers through multiple points of delivery. In many cases, automated delivery options are available for provider support in the most efficient and timely manner. Effective July 1, 2013, in an effort to focus resources on support not available through other methods, the Agency will make the following changes in the access of the following services:

  • Eligibility verification will no longer be available from call center staff.
  • The remittance advice will only be available electronically.
  • Hard copy applications will no longer be accepted except for out of state, treating provider, SMMC, and new location code applications; applications will only be accepted through the online wizard.
These changes are intended to maximize the efficiency of the services available through the options referenced. We anticipate these changes may require some adjustment for the provider community, so this notification is being sent to provide advance notice and encourage early adoption to minimize any work pattern adjustments that may be needed to support these changes. The Agency will continue its efforts to enhance services available and appreciates your role in supporting the Florida Medicaid program.
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Recipient Eligibility Verification
Typically, the Agency supports in excess of 1 million eligibility verifications each day. Effective July 1, 2013, eligibility verification will no longer be available from call center staff. Options to verify eligibility will continue to include:
  • Calling (800) 239-7560 for the self-service automated voice response system (AVRS) to verify eligibility and other automated options.
  • Online, real time verification through the secure Web Portal.
  • Batch transactions supporting standard X12 270/271 eligibility verification through the secure Web Portal.
  • A Point-of-Sale (POS) device/connection through an approved Florida Medicaid MEVS vendor.
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Remittance Advice
The remittance advice provides detail on each transaction processed by Florida Medicaid. Today, many providers take advantage of online methods to gain access to their remittance advice, speeding access and saving postage cost for the State. Effective July 1, 2013, the remittance advice will only be available electronically. The Agency will no longer mail hard copy remittance advice to providers. Options to access the weekly generated remittance advice will continue to include:
  • Electronic Remittance Advice image available on the secure portal.
  • Standard X12 835 EDI file.
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Claims Processing for Universal Health Care, Inc. Providers
Providers who have questions about claims for Medicaid members of Universal Health Care, Inc. (Universal) may visit the Receiver's website or call toll-free 1-800-882-3054.

Please note that providers may not seek payment from Universal members for debt owed by Universal for medical services. Under Section 641.3154, Florida Statutes, HMO subscribers are not liable to any provider of health care services for any services covered by the HMO.
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Support for the Council for Affordable Quality Healthcare (CAQH) CORE Policies
A new This is notification to our EDI submitters regarding the Agency for Health Care Administration’s activities supporting the Council for Affordable Quality Healthcare (CAQH) CORE policies and rules (or Operating Rules), which are intended to simplify healthcare administration through industry collaboration on public-private initiatives.

One of the points of emphasis of the CORE Operating Rules is making the accessibility of eligibility, benefits and claim information for patients easier for physicians and hospitals. This initiative is broken up into phases. The first phase involves Connectivity, Eligibility (270/271), and Claim Status (276/277), due January 2013.

Florida Medicaid is implementing Phase I of the CORE Operating Rules. The first phase impacts content of the Eligibility response and introduces a new option for transaction exchange referred to as Safe Harbor. Over the coming weeks, interested parties are encouraged to monitor the fiscal agent website for more detailed information. Our Web Portal will be modified to include a new link under EDI for CORE Operating Rules information. This link will have the latest on changes and options available as a result of this initiative. For more immediate details on changes to the 270/271 and 276/277 X12 transactions, please access the latest version of their companion guides available here.
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Medicare Part B Adjustments
On October 8, 2012, letters were sent to affected providers detailing the upcoming Medicare Part B adjustment effort. Please click here for more information on this effort....more...less