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© 2020 Florida Agency for Health Care Administration, Provider Enrollment Help Line Information, Florida Medicaid Management Information System, In-State Providers and Out-Of-State Providers, CMS Clinical Eligibility Attestation for Physicians and a list of qualifying chronic and serious conditions, CMS.ClinicalEligibilityScreening@flhealth.gov.

), Allow early refills of maintenance medication (excludes controlled substances), Eliminate restrictions on the use of mail order delivery of maintenance medications. Managed Medical Assistance (MMA) Program, Long-term Care (LTC) Program, and Dental Program. Pinellas CAD_54520M State Approved 10162018 ©WellCare 2020 FL0WMCDIR54520M_0M52. www.floridahealth.gov/findaflushot. Search Providers Page. Exceptions to the 12-month claim submission time limit may be allowed, if the claim meets certain conditions. Sunshine Health provides affordable health insurance plans and is one of the largest Florida Medicaid providers. Providers are encouraged to review the Electronic Exceptional Claim Submission Quick Reference Guide, found on the, Each exceptional claim should have its own, For additional information on exceptional claims see the Medicaid.

Some providers may not perform certain services based on religious or moral beliefs.

Extending Medicaid recipient eligibility and extending time to complete application process, Authorizing Prescribed Pediatric Extended Care (PPEC) centers to deliver services to Florida Medicaid recipients in the home setting, Waive certain electronic visit verification requirements for home health services (only), Allow payment flexibility for ambulance providers when transporting individuals requiring isolation precautions related to COVID-19, Medicaid Interim Rate Request Threshold Change for ICF providers, Reminder: Providers Cannot Charge Florida Medicaid Recipients for Personal Protective Equipment. The website is maintained outside of New York state and the insurer is not authorized to transact the business of insurance in New York. This will be used as a factor in determining their Provider Relief Fund payment. For Arizona residents: Insured by Humana Insurance Company. Some providers may not perform certain services based on religious or moral beliefs. By using this site, you agree to the If physicians have questions about the CMS Clinical Eligibility Attestation, please contact a CMS plan nurse at 1-855-901-5390. WIC is a federally funded nutrition program for Women, Infants, and Children. View all of our health insurance plans available below. State-sponsored Medicaid benefits for eligible Floridians. How to Create Positive New Habits in our New World, Medicaid Supplemental Preferred Drug List, ROPA Provider Enrollment Application Now Available. To find a vaccine, please visit Florida Medicaid contracts with a Fiscal Agent for provider enrollment, management of the beneficiary file/records Medicaid Fee-For-Service claims processing and payment.

Provider Support provides research and technical support for Medicaid Fee-For-Service claims inquiries and processing issue resolution.

Child Quality Measure Data. Florida Medicaid contracts with the following entity to perform Prior Authorization/Utilization Management services. Federal HHS has announced Phase 3 for General Distributions from the CARES Act Provider Relief Fund. For costs and complete details of the coverage, refer to the plan document or call or write Humana, or your Humana insurance agent or broker. A minimum one-year, initial contract period may be required for some dental and vision plans, excluding Dental Savings Plus. The goals of the program are to include Floridians of all ages with disabilities in all of the Department Waive frequency and duration service limits for behavioral health services, Expand telemedicine/telehealth services in the fee-for-service delivery system (remote patient monitoring, store and forward) for physicians, APRNs, physician assistants, Additional guidance to BA providers related to telemedicine services, Implements payment parity for services delivered via telemedicine (audio and video) in the SMMC program, Establishes requirements for telephone-only communications, Well-child visits provided via telemedicine during COVID-19 State of Emergency, Enact provisional enrollment to quickly enroll providers currently enrolled in Medicaid, Waive requirement that Medicaid providers be licensed in-state, Restart of Medicaid provider enrollment revalidation process, Postpone on-site or face-to-face provider site visits (including enrollment/credentialing requirements), Allow enrollees more time to request a fair hearing or health plan appeals, Postpone Preadmission Screening and Resident Review (PASRR) Level I and PASRR Level II activities. It is funded by both the state and federal governments. Or start a search using our Find A Provider tool. This plan is offered by the Florida Department of Health who has contracted with WellCare of Florida, Inc to provide managed care services to our members.  You can visit www.CMSPlanFlorida.gov to learn more. If you are not enrolled with Sunshine Health, review Get Insured for more information.

Medicaid provides healthcare coverage for income-eligible children, seniors, disabled adults and pregnant women. Not available with all Humana health plans. population. Federal HHS has established a Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP providers to report their annual patient revenue. Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. Administered by Humana Insurance Company. Florida Medicaid enrolled hospital providers may elect to make presumptive eligibility determinations in accordance with federal law and state policy. Together with our community-based care partners, we are improving the health and well-being of these children through coordinated care, services and support. In the event of any disagreement between this communication and the plan document, the plan document will control. Serious outcomes of flu infection are hospitalization or death. Addtional federal COVID-19 relief funding is now available for Medicaid and CHIP providers. Influenza. Humana individual life insurance plans are offered in New York by Humana Insurance Company. Find Medicaid Doctors, Dentists, and Specialists "To find doctors, dentists, and specialists in your community that serve Medicaid patients, go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a Choice Counselor." State Staff ONLY Password Resets Monday - Friday 7:30 AM - 6 PM ET 850-298-7123 Providers and Agents Refer to the Secure Web Portal Maintenance Quick Reference Guide for assistance. Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc., or insured by Humana Health Insurance Company of Florida, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Insurance Company, Humana Insurance Company of Kentucky, or Humana Insurance of Puerto Rico, Inc. License # 00187-0009, or administered by Humana Insurance Company or Humana Health Plan, Inc. For Arizona residents, plans are offered by Humana Health Plan, Inc. or insured by Humana Insurance Company. Important Information for All Medicaid Providers – Act Now! Statements in languages other than English contained in the advertisement do not necessarily reflect the exact contents of the policy written in English, because of possible linguistic differences. The Disability and Health Program (DHP) is funded by a three-year grant from the Centers for Disease Control and Prevention (CDC). Ambetter offers affordable health care coverage for individuals and families. CAD_56467M State Approved 01082019 ©WellCare 2020 . Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. The statewide toll-free hotline offers counseling information and referrals about Program eligibility depends on your age, income, family size and any special health needs you may have. Tools and resources to help you and your family prepare for any disaster.

For assistance contact 1-877-254-1055. Depending on your family size and income, you may even qualify for help to pay your monthly premium. The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Back to Medicare and Medicaid information, Humana legal entities that offer, underwrite, administer or insure insurance products and services. If you are the treating physician of a child and you would like to attest to the eligibility of your patient for the CMS plan, please review the CMS Clinical Eligibility Attestation for Physicians and a list of qualifying chronic and serious conditions. This communication provides a general description of certain identified insurance or non-insurance benefits provided under one or more of our health benefit plans. Florida is currently experiencing a moderately severe influenza season. You will need Adobe Reader to open PDFs on this site. Federal HHS has announced Phase 3 for General Distributions from the CARES Act Provider Relief Fund. Provider(s) must verify each recipient’s eligibility each time a service is rendered. Expanded provider qualifications for LTC services to allow additional providers to render services when there are workforce shortages, location closures, etc. View plan provisions or check with your sales representative. Influenza or 'flu' is a viral respiratory illness, mainly spread by droplets made when people with flu cough, sneeze

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Please note that a new browser window will open. Health Plan Portal User Manual Secure Web Portal User Guide Reset an Account Password Quick Reference Guide Provider Enrollment is responsible for enrolling qualified providers to receive Medicaid reimbursement for services rendered to Medicaid Fee-For-Service recipients. 1. Download the free version of Adobe Reader. For Texas residents: Insured or offered by Humana Insurance Company, HumanaDental Insurance Company or DentiCare, Inc (d/b/a Compbenefits). Sunshine Health offers health insurance plans that fit your unique needs. Region 3: Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union counties, Region 4: Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties, Region 6: Hardee, Highlands, Hillsborough, Manatee and Polk counties, Region 7: Brevard, Orange, Osceola and Seminole counties, Region 8: Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties, Region 9: Indian River, Martin, Okeechobee, Palm Beach and St. Lucie counties, Region 11: Miami-Dade and Monroe counties. WIC provides the following at no cost: healthy foods, nutrition education and counseling, breastfeeding support, and referrals for health care.

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