Frequently Asked Questions
Find answers to the most frequently asked questions here.
Medicaid Modernization
When will the new provider enrollment system be launched?
The new provider enrollment system is scheduled to launch in 2026 as part of the broader Medicaid modernization efforts.
How will the new system improve a provider’s experience?
The new provider enrollment system will simplify processes by reducing administrative burdens, enhancing security, and providing easy access to provider-related tasks within a single portal. This leads to faster application processing and fewer errors. The system works well on mobile devices and is available 24/7, so providers can enroll, renew, and update their information anytime. It also lets providers upload documents and check the status of their requests in real time.
How can I prepare for the transition to the new system?
- Complete pending enrollments in the current Medicaid Provider Enrollment Application Wizard.
- Review and update account information in the current Medicaid Secure Web Portal. If renewal has been triggered, complete renewal in the Medicaid Secure Web Portal.
- Active Medicaid Providers who have not created an account should do so as soon as possible. Providers who do not have their PIN information should see Password Resets and PINs for additional support.
- Subscribe to Florida Medicaid Health Care Alerts for updates.
Diligent account maintenance is vital for smooth transition into the new provider enrollment system, uninterrupted claims processing, and for receiving program updates and compliance notifications from AHCA.
What if I have multiple Florida Medicaid accounts today?
Ensure that each of the Florida Medicaid accounts is up to date.
How can I sign up for Florida Medicaid Health Care Alerts?
Sign up for alerts by visiting the Florida Agency for Health Care Administration's website at ahca.myflorida.com/alerts and following the subscription instructions.
Where can I find more detailed information about the changes?
Detailed information can be found on the AHCA Enterprise Provider Page, which also includes FAQs, guides, and updates related to the implementation of the new provider enrollment system.
Automated Voice Response System (AVRS)
Do I need a password to log in to the Automated Voice Response system?
No, a password is not required. A valid Provider Medicaid ID is required.
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.
Billing General
What are my options for claim submission?
The three main options for claim submission are:
- Web Direct Data Entry (DDE)
- Billing Software Purchase
- Use a Billing Agent or a Clearinghouse
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.
Where do I address questions regarding billing?
Providers have a number of resources available to assist them. These include:
- Provider handbooks are no longer available on the Web Portal; these can be found on AHCA’s Adopted Rules - Main Page.
- Web Based Training (WBT) available on the Web Portal.
- Provider Services Contact Center at 1-800-289-7799 (Option 7).
- Billing issues regarding a plan, contact plan directly - Provider Network Contact List.
- Additional billing issues can be addressed by submitting a complaint - How to File a Complaint.
- Local Medicaid Field offices.
How often will payments be made?
Payments are made weekly, based on the claims submitted during the processing week.
Under what circumstances 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).
Where can I find downloadable handbooks in the Web Portal?
The Medicaid Handbooks are no longer available on the Web Portal. They are available on AHCA’s Adopted Rules - Main Page.
Change of Ownership (CHOW)
What constitutes a Change of Ownership?
Section 409.901(5), F.S., defines a change of ownership as follows: "(a) An event in which the provider ownership changes to a different individual entity as evidenced by a change in federal employer identification number or taxpayer identification number; (b) An event in which 51 percent or more of the ownership, shares, membership, or controlling interest of a provider is in any manner transferred or otherwise reassigned; this includes the death of the previous owner
What documentation is required when reporting a Change of Ownership?
A bill of sale, a stock purchase agreement, or other notarized legal document that indicates the legal action that took place, along with any other documents required for the provider type enrolling with a standard Medicaid application.
Does Florida Medicaid allow buyers to submit a Change of Ownership application when the provider type or enrollment type differs from the seller’s file? For example, the buyer wants to submit a fully enrolled Change of Ownership application, and the seller has an enrollment type of registered or limited. Or the buyer wants to submit a PT 67 Change of Ownership application and the buyer is a PT 65.
This would be wholly dependent upon the circumstances and provider types of the seller and buyer. In cases of differing provider types, i.e. a 67 and 65, things like existing moratoriums would prohibit a PT67 selling their business to a buyer who has the intent to open a new HHA (PT65) as this would be seen as the buyer and seller trying to circumvent the moratorium. In most other cases, the provider types would simply be incompatible to do so.
If the provider was sold the business and the seller’s file is in a renewal, how would the buyer move forward with the Change of Ownership process?
The seller would need to complete their renewal first, to ensure that they are still an eligible provider.
What is the best way to notify AHCA of a Change of Ownership before a provider submits their Change of Ownership application?
The seller should upload a letter of intent to their Secure Web Portal account.
How long before a Change of Ownership does a provider have to notify AHCA of the change?
At least 60 days prior.
What happens if a provider does not notify AHCA of the Change of Ownership within the allotted time frame?
If the buyer does not submit the new application until after the sale has taken place, there will be a gap in coverage and both the seller and the buyer shall be jointly and individually liable for all overpayments, administrative fines, and other moneys due to AHCA, regardless of whether AHCA identified the overpayments, administrative fines, or other moneys before or after the effective date of the change of ownership. AHCA may not approve a transferee's Medicaid provider enrollment application if the transferee or transferor has not paid or agreed in writing to a payment plan for all outstanding overpayments, administrative fines, and other moneys due to AHCA.
If a business entity has majority ownership of a provider file, who is authorized to sign the Bill of Sale?
Whoever the buyer or seller has designated as an authorized signer on their file.
If the owner of the seller’s file no longer works at the business or cannot be contacted, how should the buyer initiate the Change of Ownership?
The buyer would submit a new application as usual, marking that the application is in response to a Change of Ownership, as Medicaid would need to know who the seller is so that we can attempt to reach the individual in order to terminate his or her Medicaid provider ID. The buyer should also submit a letter explaining the situation so that Medicaid is aware of the circumstances surrounding the transaction.
Ownership information is not collected when completing provider registration applications. Are registered providers required to report a Change of Ownership?
Yes – please see the section regarding providers who may be under moratorium.
Can a Change of Ownership be done for sole proprietors enrolled with a FEIN?
No. Change of Ownerships are only valid for group and/or facility applications.
If ownership changes due to death, what proof of documentation should a provider submit and where/how should they submit it?
A copy of the death certificate should be submitted with the new Change of Ownership application.
General
What are the telephone numbers to reach Florida Medicaid?
- Call 1-800-289-7799 for Provider Enrollment (Option 4), Password Reset (Option 5), and the Provider Services Contact Center (Option 7).
- Call 1-877-254-1055 to reach the Recipient and Provider Assistance Medicaid Helpline Contact Center.
- Call 1-800-239-7560 for the self-service, automated voice response system (AVRS) to verify eligibility and for other automated options.
- Call 1-866-586-0961 to reach Electronic Data Interchange (EDI) services unit.
What internet browser should be used when viewing the Florida Medicaid Web Portal?
We recommend viewing the Florida Medicaid Web Portal with Microsoft Edge Chromium or Google Chrome, as other browsers such as Internet Explorer, Opera, or Safari may not support the features required for use with the web portal.
How do I request assistance with using the Florida Medicaid Web Portal?
You can view the Contact Us article if you are having trouble using the Web Portal or you may contact the Provider Services Contact Center by phone, at 1-800-289-7799 (Option 7).
What are my options for receiving a Remittance Advice (RA)?
The two options available for receiving an RA include:
- Electronic RA image available on the Web Portal.
- X12 835 file.
Can I request a paper copy of a Remittance Advice (RA)?
Yes. There is a charge of $0.50 per page to print a paper RA. Make the request by calling the Provider Services Contact Center at 1-800-289-7799 (Option 7).
What are my options for determining a recipient's eligibility?
Providers with a valid Medicaid Provider ID can use any of the following:
- A Point-of-Sale (POS) device through an approved Florida Medicaid MEVS vendor.
- The Florida Medicaid Web Portal.
- The Automated Voice Response System (AVRS).
- X12 270/271 eligibility transactions via EDI.
Certain options may require a password.
Where can I obtain information on Ad Hoc reports?
Information on Ad Hoc reports is available here.
Who can I contact if I need assistance with password reset or PIN related questions?
Please refer to the Help with Secure Web Portal Password Resets page for assistance.
Where can I obtain a list of Internal Control Number (ICN) region codes?
A document detailing the ICN region codes is available here.
Where can I obtain a list of common eQHealth error codes?
A document providing a list of the most common eQHealth error codes is available here.
National Correct Coding Initiative (NCCI)
What is NCCI?
The NCCI 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 NCCI 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.
How many modifiers will the system accept?
The system will accept up to 2 modifiers.
Does NCCI use 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.
What types of claims are affected by NCCI?
Only Professional, Dental, and Outpatient claims are affected. NCCI does not apply to COBA-submitted Medicare Crossover claims, as the COBA processer would have already applied NCCI editing.
National Provider ID (NPI)
When do I have to include an NPI and taxonomy number?
Florida Medicaid Providers with multiple Medicaid Provider IDs should submit their NPI, taxonomy associated with their specialty, and, in some cases their service location ZIP+4 and address, to create a unique match to their Medicaid Provider IDs. If the taxonomy or ZIP+4 is used to create this match, these elements become required data in the billing, pay-to and treating provider loops on an X12 claim transaction.
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 Code Set consists of two (2) parts: individuals (e.g., physicians) and non-individuals (e.g., ambulatory health care facilities). All codes are alphanumeric and are ten (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 (1) 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: https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers/health-care-taxonomy) Providers can refer to the Taxonomy Master List (TML) on the NPI Initiative page of the public Web Portal to view and complete a list of taxonomies accepted by Florida Medicaid.
How do I send/update my NPI and/or taxonomy information?
Providers can send/update NPI information using the NPI self-service tool. Providers can access the NPI self-service tool by visiting https://portal.flmmis.com and logging into the secure Web Portal using the appropriate account credentials. From the secure Web Portal landing page, select Demographic Maintenance. For additional guidance on updating a provider's NPI information, please review NPI Self-Service Quick Reference Guide.
How does the Agency determine the service location for processing claims and payment when I bill with the NPI?
If a provider has only one (1) Medicaid Provider ID, the NPI alone will match to the correct Medicaid ID for processing the claim. Providers with multiple Medicaid Provider IDs should submit their NPI, taxonomy associated with their specialty, and, in some cases, their service location ZIP+4 and address to create a unique match to their Medicaid Provider IDs. If the taxonomy or ZIP+4 is used to create this match, these elements become required data in the billing, pay-to, and treating provider loops on an X12 transaction in order for the claim to process.
What is the NPI Initiative?
The NPI Initiative resulted in the enhancement of several NPI related tools and documents that assist providers and health plans to better understand the NPI information to include on their electronic claim and encounter submissions as well as make it easier to research their enrollment(s) and related NPI denials.
Note: All NPI Initiative enhancements were implemented on October 26, 2023, with the exception of the NPI Mapping Logic updates and NPI to Medicaid ID Search Engine enhancements, which were implemented on February 15, 2024.
What changes were made?
he following updates were implemented with this initiative:
- NPI Mapping Logic (Effective February 15, 2024)
- The NPI Mapping Logic only considers matching to enrolled Medicaid Provider IDs with Contract Date spans (Effective/End Dates) that were active during the submitted Date of Service.
- NPI to Medicaid ID Search Engine (Effective February 15, 2024)
- The tool was removed from the public Web Portal and is solely available on the provider’s secure Web Portal and the Health Plan Portal.
- A link was added that allows providers to view all valid taxonomies for the specialty/specialties they have on file.
- The following new data columns were added to the NPI to Medicaid ID Search Engine:
- Provider Type
- Specialty
- Contract Effective and End Dates
- Provider Master List (PML) – The PML was updated to reflect the removal of NPI Crosswalk related columns.
- Pending Provider List (PPL) – The PPL was updated to reflect the removal of NPI Crosswalk related columns.
- Taxonomy Master List (TML)
- The TML replaced the Taxonomy Guide and is available for downloading in a similar layout as the PML/PPL.
- The TML also includes the Provider Type number and the Provider Specialty number.
- A new TML Tip Sheet has been made available to provide guidance on how to navigate the new TML.
Why were these changes needed?
The goal of this initiative was to simplify the process of determining a provider’s NPI information that should be included on X12 837 transactions as well as the process of selecting a taxonomy that is appropriate for the provider’s specialty.
Which providers are impacted by this initiative?
This initiative impacts all providers who submit X12 837 transactions and are required to include an NPI on their submissions
Did submission requirements change?
No. This enhancement helps providers and health plans easily identify NPI and taxonomy information to include on their X12 837 transactions
What is the current process to update an NPI?
The NPI self-service tool is available to all providers via the secure Web Portal. This self- service tool replaced the NPI Registration Form. The NPI panel allows providers to update or add a new NPI to the Medicaid Provider ID associated to the account the provider is logged into.
- The new NPI information will default the NPI Effective Date to the day the new NPI information was added to the provider’s file. Providers can enter a new Effective Date if desired. Note: Taxonomy and Zip+4 information will not be captured.
- The replaced NPI is End Dated to the day prior to the Effective Date of the new NPI.
- Providers will need to repeat this process for each provider file that needs to be updated with a new NPI.
- Providers are able to verify an NPI using the NPI to Medicaid ID Search Engine tool available via the secure Web Portal. Providers can search for all Medicaid Provider IDs associated to an NPI without having to navigate away from their secure account to use other resources to find this information.
What changes were made to the NPI to Medicaid ID Search Engine?
As of February 15, 2024, providers can use the NPI to Medicaid ID Search Engine self-service tool on the secure Web Portal located under Quick Links to view Medicaid Provider IDs associated with a provider’s NPI. The tool displays the following enhancements:
- Additional search criteria input boxes were added allowing providers to simulate the data used for matching that they submit on their X12 837 transactions.
- The NPI to Medicaid ID Search Engine executes the NPI Matching Logic using the entered search criteria and displays the resulting Medicaid Provider ID(s) that they would match to in their X12 837 submissions.
- The NPI to Medicaid ID Search Engine displays an indicator to identify the Medicaid Provider ID/service location that the NPI mapping logic will default to when there are multiple identical service locations for a single NPI.
- The following new data columns were added to the NPI to Medicaid ID Search Engine:
- Provider Type;
- Specialty; and
- Contract Effective and End Dates.
- A link was added that allows providers to view all valid taxonomies for the specialty they have on file.
- Wording was added to clarify that all taxonomies associated with a provider’s specialty will be accepted on X12 837 transactions and providers are not limited to submitting the specialty taxonomy that they have on file.
How was the NPI Mapping Logic updated?
The NPI Mapping Logic has the following updates, as of February 15, 2024:
- The mapping logic only considers Medicaid Provider IDs with Contract Date spans (Effective/End Dates) that were active during the submitted date of service.
- The default logic is executed when multiple Medicaid Provider IDs are identified, but cannot match to a single Medicaid Provider ID. The default logic will continue to select the Medicaid Provider ID with the oldest. Contract Effective Date from among the multiple Medicaid Provider IDs narrowed down to that point in the logic.
As of February 15, 2024, how does FLMMIS identify the desired Medicaid record/service location?
Submitted data is compared to provider enrollment data to ascertain the desired Medicaid Provider ID in the following way:
- The submitted NPI is matched to an NPI active for the date of service.
- The NPI Mapping Logic only considers matching to enrolled Medicaid Provider IDs with Contract Date spans (Effective/End Dates) that were active during the submitted Date of Service.
- If there are multiple Medicaid records associated with an NPI, then the submitted taxonomy is matched to a singular associated Specialty and Provider Type appropriate for the submitted taxonomy.
- If there are multiple records associated to the Provider Type, the submitted Zip+4 (nine (9) digits) is compared to the service location Zip+4 (nine (9) digits).
- If there are no matches to the submitted Zip+4, then the submitted Zip code (five (5) digits) is compared to Zip code (five (5) digits) on file.
- If there are multiple matching Zip+4s, the submitted Address Line 1 is compared to the service location addresses’ Line 1s.
- When multiple potential Medicaid Provider ID matches are identified and the submitted data cannot uniquely match a single Medicaid Provider ID, the default logic will continue to select the Medicaid Provider ID with the oldest Contract Effective Date from among the multiple Medicaid Provider IDs narrowed down to at that point in the logic.
Note: To view the default provider Medicaid ID, refer to the NPI to Medicaid ID Search Engine tool, available on the Florida Medicaid Secure Web Portal and the Health Plan Portal. The NPI is a required data element to view all associated Provider Medicaid IDs and the default Provider Medicaid ID. Entering additional data elements in the tool will display more precise results. Guidance to use the tool can be found on the NPI to Medicaid ID Search Engine QRG.
Will claims/encounters reject if a taxonomy is not submitted on a claim?
Submitted X12 837 data is utilized to acquire the Medicaid Provider ID and associated service location. If the submitted NPI alone is sufficient to acquire the Medicaid Provider ID, meaning there is only one (1) Medicaid Provider ID associated with the submitted NPI; a taxonomy would not be required to make that determination and would not post a denial edit for that reason.
If providers submit claims to health plans that omit the taxonomy or have an incorrect taxonomy, can health plans add or correct those taxonomies?
Health plans cannot alter provider-submitted taxonomy data on encounters subsequently submitted to Florida Medicaid. The provider would be required to make the correction and work with the health plan to resubmit the encounter data.
How will health plans know when encounters do not make a match to a Medicaid Provider ID or default to a Medicaid Provider ID?
Encounters that do not match to a Medicaid Provider ID will post specific denial edits detailing why a Medicaid Provider ID was not found in FMMIS; the CARC/RARC codes associated with those denial edits are returned on the 835. Health plans would be responsible for notifying the submitting provider of their submission error(s) to be corrected and resubmitted. For those encounters that have multiple Medicaid Provider IDs with the same service location, the system will default to the Medicaid Provider ID with the oldest contract effective date ranges and post a “Pay” (Informational on encounters) edit. Most CARC/RARC codes associated with “Pay” (Informational on encounters) edits are not returned on the 835s
What address should be entered in the Address Box 33 of the CMS1500 paper claim form?
Address Box 33 of the CMS-1500 paper claim form needs to match the billing provider’s service location address that is on the provider file. The address can be confirmed by:
- Logging into the secure Web Portal and navigating to the demographic maintenance and clicking the NPI link.
- Going to the public Web Portal, selecting Agency Initiatives, NPI Initiative, PML, and referring to column G of the Provider Master List (PML).
Note: The Agency only accepts the CMS-1500 paper claim form for out-of-state providers and in specific situations. For X12 transactions, Loop 2010AA Segment N3 BILLING PROVIDER ADDRESS must include the service location address that the provider has on file with Florida Medicaid; Loop 2010AB Segment N3 PAY-TO ADDRESS must include the pay-to address if different from the address included within Loop 2010AA.
What changes were made to the Provider Master List (PML)?
The following NPI Crosswalk related columns were removed from the PML:
- NPI Crosswalk - Taxonomy
- NPI Crosswalk - ZIP Code
- NPI Crosswalk - Date Used for Claims
Refer to the PML Tip Sheet for additional information.
Are Medicare Crossovers included within the scope of the new organization provider (Type 2) requirements?
Practitioner organization providers (that are not required to have a unique NPI for each service location) can continue to submit Medicare claims using the same NPI they have been submitting but may also need to include the following with their submissions:
- Taxonomy, billing address, and Zip+4 matching their service location as described above.
Institutional organization providers are required to submit an NPI and taxonomy consistent with the new enrollment requirements of one (1) NPI to billing location. This may also require reconciliation or realignment of provider Medicare enrollments to accommodate individual provider billing location needs.
Where can I find more information about the NPI Initiative?
The AHCA Enterprise has recent postings related to this project:
- NPI Initiative page
- EDI Companion Guides
- For enrollment related inquiries, providers can call the Florida Medicaid Provider Enrollment Contact Center at 1-800-289-7799, Option 4; or to request their local plan and provider services specialist, select Option 7
Enrollment
Are providers required to submit Provider Enrollment applications on the Web Portal?
Yes, an interactive Enrollment Wizard assists providers wishing to enroll in the Florida Medicaid program. Potential providers will also be able to upload attachments as may be required when enrolling.
Signed documents may be scanned and uploaded to Medicaid.
Additional information can be found in Out-of-State Provider Enrollment.
On-Line Enrollment Wizard
What types of internet browsers are supported by the On-Line Enrollment Wizard?
The On-Line Enrollment Wizard supports multiple internet browsers including the following:
- Internet Explorer 11
- Firefox (version 1.5 or later)
- Opera (version 8.5 or later)
How do I upload supporting documentation for a new application?
Applicants have two choices for uploading supporting documentation:
- Clicking the “Upload Required Documents” link that appears at the bottom of the page immediately after submission of the application and before leaving the Enrollment Wizard.
Note: All uploaded documents, regardless of submission method, must be submitted in either a PDF or TIFF format.
How do I make corrections to an application that has been submitted?
Correction may be made directly on a copy of the printed application and then uploaded as described above. Using whiteout and crossing out items is acceptable.
How do I return to a saved application in order to continue entering information and submit it for processing?
In order to continue the application, the Application Tracking Number (ATN) and either the Last Name or Business Name, whichever used on the application, will be required.
- Click On-line Enrollment Wizard link.
- Click continue application button on the lower right side.
- Enter the ATN and either the Business or Last Name as used on the application. The name must be entered exactly as it was entered on the application.
- Click Search button.
- Users may review the previous submissions and make changes or corrections and continue the application.
Which provider type should I choose?
Please refer to the Provider Enrollment Policy for instructions on how to select a Provider Type for the application.
Why do I keep receiving an “overlapping dates” error?
Check the application for “Member of the Following Groups” to make sure the effective date was not entered prior to the date of this application. Also, check that the provider number has only been used one time.
I’m applying as an “Individual Enrolling as a Member of a Group” and I do not have the group provider number. Why can’t I move past the “Member of the Following Groups” page?
Select and delete any duplicate or blank line items. Once the page is blank, save and continue to the next page.
Why does the “Owners and Operators” page continue to ask for additional information?
Make sure all the required information is completed for each individual included on the application. If that does not resolve the error, select and delete any duplicate or blank line items.
Renewal
Where do I find the online renewal application?
As of July 11, 2014, provider renewal enrollment in Florida Medicaid is available via the secure Web Portal. Eligible providers can access the Renewal Application in the Quick Links dialog box on their Florida Medicaid Secure Web Portal account landing page.
I am having difficulty navigating through the renewal application. What do I do?
For assistance with completing the renewal application, please contact the Provider Enrollment Call Center at 1-800-289-7799, Option 4.
I submitted my renewal application and want to check the status of my application. How do I do that?
The Renewal Application link, from the Quick Links menu, will automatically redirect users to the Renewal Status page, once their application has been submitted. Users can view the current status of their renewal application, upload documents, and print a copy of their renewal application.
I submitted my renewal application but need to make a correction. How do I do that?
The Renewal Application link, from the Quick Links menu, will automatically redirect users to the Renewal Status page, once their application has been submitted. In order to correct the application, print a copy of the renewal applications, write in the desired corrections, and upload the modified application for processing.
What is considered proof of a current Medicaid eligible background screening?
Providers must have a current Florida Medicaid eligible screening in the Care Provider Background Screening Clearinghouse (Clearinghouse) for each person disclosed on the application.
Out-of-state providers and owners/operators of business entities who are known to PECOS (Medicare’s provider enrollment database) are permitted to utilize their approved statuses in the PECOS system to meet Florida Medicaid’s provider background screening requirements to remain enrolled (renew) as out-of-state Florida Medicaid providers.
Providers exempt from the criminal history checks, such as not-for-profit organizations or government-owned facilities, must submit the fingerprinting exemption form with their renewal application. The Fingerprinting Exemption forms are available on the Enrollment Forms page of the public Web portal.
More information about background screening is available on the Agency's Web Portal.
I already submitted my renewal application but received another notice. What do I do?
Contact Provider Enrollment at 1-800-289-7799, Option 4 to verify the status of your renewal application and to discuss any possible deficiencies requiring submission of corrected forms or additional supporting documentation.
My claims are suspending because renewal was not completed before the deadline. What do I do?
Contact Provider Enrollment at 1-800-289-7799, Option 4 to verify the status of your renewal application and to discuss any possible deficiencies requiring submission of corrected forms or additional supporting documentation.
When will my suspended claims be released?
Upon completion of the renewal process, the suspended claims will be released. Please contact Provider Enrollment at 1-800-289-7799, Option 4 to verify the status of your renewal application and to discuss any possible deficiencies requiring submission of corrected forms or additional supporting documentation.
I received a notice to renew, but the location in question has closed or otherwise ceased operations. What do I do?
If any of the service locations associated with the base number have closed, the provider must report the closure to the Medicaid fiscal agent. The request must contain the full nine-digit Medicaid ID for the closed service location and the effective date of the closure. The provider can upload this information using the provider file maintenance self-service tool in the Florida Medicaid Secure Web Portal. Please select the Provider File Maintenance- Voluntary Termination document type, when uploading the request.
Where do I find Medicaid forms such as the Medicaid Provider Agreements?
Medicaid forms are available on Enrollment Forms page.
How do I update ownership information?
Providers who are reporting a change of 51 percent or more of ownership cannot do so during the provider renewal process. This change will require the buyer to submit a new enrollment application via the Online Enrollment Wizard.
Providers reporting a change of ownership of less than 51 percent, can add new owners and adjust percentages in the Owner and Operators panel of the renewal application.
Individuals with five (5) percent or greater ownership or controlling interest in the provider, and all managing employees must have a current Florida Medicaid eligible screening in the Care Provider Background Screening Clearinghouse (Clearinghouse), or proof of fingerprinting exemption.
Referring, Ordering, Prescribing, and Attending (ROPA) Providers
What is a ROPA provider?
A ROPA provider orders or refers patients for Medicaid services, prescribes prescription drugs to Medicaid recipients, and/or serves as the attending practitioner in institutional settings for Medicaid recipients. ROPA providers may be identified as the referring, ordering, prescribing, or attending provider on professional, pharmacy, institutional, or dental claims.
Where can I find the law requiring ROPA providers to be enrolled?
Title 42, Code of Federal Regulations, Section 455.410(b) requires all ordering or referring physicians or other professionals providing services to Medicaid recipients to enroll as participating providers with the state Medicaid agency.
What is ROPA Enrollment?
The Florida Medicaid ROPA enrollment online application features a fully-automated process through which ROPA practitioners, licensed by the Florida Department of Health, can enroll with Florida Medicaid.
How can a ROPA provider enroll with Florida Medicaid?
ROPA providers may complete the online application using the Florida Medicaid Provider Enrollment Application Wizard.
What billed services require identification of a ROPA provider on the claim or encounter?
Providers who know, or have reason to believe, there was a referring, ordering, or attending provider are required to identify the referring, ordering, or attending provider by their NPI number on the claim. All pharmacy claims must identify the prescribing physician or other practitioner by their NPI number.
I am already enrolled as a Florida Medicaid provider. Do I need to re-enroll as a ROPA provider?
No, if you are currently enrolled you do not require an additional ROPA enrollment in order to continue referring, ordering, prescribing, or attending for Medicaid recipients.
If I am a ROPA enrolled provider, can I later apply to become fully enrolled in order to bill fee-for-service or a health plan?
Yes, a ROPA enrolled provider may submit a new application to apply for full enrollment with Florida Medicaid.
Are ROPA enrolled providers able to bill claims to Medicaid or a Medicaid health plan?
No. Providers must be fully enrolled in order to bill fee-for-service claims to Florida Medicaid or be identified as the rendering practitioner on claims. Providers must be fully or limited enrolled in order to bill claims to a Florida Medicaid health plan or be identified as the rendering practitioner on claims submitted to a Florida Medicaid health plan.
How can a biller verify whether a provider is known to the Florida Medicaid program?
Providers who want to verify whether a ROPA provider is enrolled in Florida Medicaid, are offered three methods to identify unenrolled ROPA providers. Each method is described below:
- URPL (Unenrolled ROPA Provider List) – The URPL is a resource available for all Florida Medicaid billing providers. The URPL contains a listing of unenrolled ROPA providers who have been identified on fee-for-service claims. These unenrolled ROPA providers are identified by their NPI. The URPL is updated on a quarterly basis and is available in the Resources section of the Referring, Ordering, Prescribing, and Attending (ROPA) Provider Enrollment page of the public Web Portal. Please note, providers identified on the URPL have not been validated to qualify for ROPA provider enrollment. Although a ROPA provider’s NPI may be listed on the URPL, the provider must meet the enrollment requirements described in the ROPA Provider Enrollment Overview Quick Reference Guide (QRG).
- NPI to Medicaid ID Search Engine – Billing providers may verify whether a provider is known to Florida Medicaid by using the search option found on the NPI to Medicaid ID Search Engine. Users will find a link to the search engine in the Resources section of the ROPA Provider Enrollment page. If a Provider is known to Florida Medicaid, entering their NPI in the search engine will identify the provider’s Medicaid ID, enrollment type, and other useful information.
- Claims Edits – Informational only edits related to compliance with the ROPA requirements began on August 15, 2019. Claims edits will be enforced effective October 1, 2021. The error codes and Explanation of Benefit (EOB) codes, and Claim Adjustment Reason Code/Remittance Advice Remark Code (CARC/RARC) combinations may be found in the ROPA Claims Changes QRGs. Billing providers may log onto their account on the secure Web Portal to view the PDF of their remittance advices.
Are ROPA enrolled providers required to participate in the network of a Medicaid health plan or render services in a fee-for-service setting?
No. ROPA enrolled providers are not required to participate in the network of a Medicaid health plan or become a Medicaid fee-for-service provider.
Who should I contact for additional questions regarding ROPA enrollment?
You may contact the Provider Enrollment Contact Center for any additional questions you may have about the ROPA provider enrollment process, or if you require any assistance, at 1-800-289-7799, option 4.
Are out-of-state ROPA providers required to enroll with Florida Medicaid?
The federal requirement to enroll ROPA providers applies equally to in-state and out-of-state ROPA providers. The ROPA online enrollment application is available only for practitioners who have an active Florida Department of Health license. If you do not have a valid Florida Department of Health license and you are an out-of-state ROPA provider located in Georgia or Alabama within 50 miles of the Florida state line, you may complete the online application to enroll as an in-state provider. Choose the option “to bill for services and receive payment directly from Medicaid.” All other out-of-state ROPA providers should refer to the Out-of-State Enrollments page for more information on how to enroll.
Does the ROPA enrollment requirement apply to the Children’s Health Insurance Program (CHIP)?
Yes, the federal enrollment requirement applies to providers who refer, order, prescribe, or attend for CHIP members.
Does the ROPA enrollment requirement apply to cross-over claims submitted for dual-eligible Medicare-Medicaid patients?
Yes, the federal enrollment requirement applies to providers who refer, order, prescribe, or attend Medicaid services for dual-eligible Medicare-Medicaid patients.
I am a physician assistant (or physician or advanced practice registered nurse) in a group practice and I am enrolled as an individual Florida Medicaid provider. My services are billed through my group practice. Do I need to also enroll as a ROPA provider?
No, you are already enrolled with Medicaid as required by federal regulations. Use your individual NPI for orders and referrals.
I am employed as a physician (or physician assistant or advanced practice registered nurse) with a Rural Health Clinic, and my services are billed through the clinic, but I am not individually enrolled with Florida Medicaid. Do I need to enroll as a ROPA provider?
Yes, since you have not been individually enrolled with Medicaid, you should enroll for the purposes of referring, ordering, prescribing or attending for services for your patients. The clinic’s NPI for orders or referrals may not be used. ROPA providers identified on claims and encounters must correspond to an individual practitioner. The same is true for providers employed by a Federally Qualified Health Center.
Are hospitalists required to enroll as ROPA providers?
Yes, the federal enrollment requirement applies to hospitalists who write prescriptions or make referrals or orders for Medicaid recipients.
Are interns or medical residents required to enroll as ROPA providers?
Resident Physicians, Interns, Fellows, and House Physicians who do not have a medical doctor or osteopathic physician license cannot enroll with Florida Medicaid. The NPI of the licensed supervising medical doctor or osteopathic physician must be reported as the ROPA provider on claims for services that are performed by Resident Physicians, Interns, Fellows, and House Physicians for Florida Medicaid recipients.
Health Plan ROPA FAQs
Does the ROPA enrollment type meet the enrollment requirements for health plan participating providers?
No, ROPA enrollment is applicable to providers who only refer, order, prescribe, or attend and are not identified as the billing or rendering provider on encounters submitted by health plans. Health plan participating providers that render and/or bill for Medicaid services must have a Full or Limited enrollment. Providers submitted on a health plan’s Provider Network Verification (PNV) submission who only have a ROPA enrollment will receive the following warning message: “Warning: Enrollment Type ROPA not permitted for PNV Network Standards.”
How does the ROPA enrollment type and ROPA requirements impact health plans?
The federal enrollment requirement for providers who only order or refer services for health plan enrollees does not extend to providers designated as out-of-network or who do not meet the definition of a network provider in 42 CFR 438.2. Therefore, the ROPA enrollment type is not applicable for health plan participating providers, and ROPA-related claim edits are not applicable to health plan encounter submissions.
Are ROPA enrollment requirements applicable when the health plan is secondary, such as when the health plan enrollee has Medicare or other primary insurance?
Medicare and other insurance ROPA providers are subject to enrollment requirements to the extent these providers are also participating in your health plan.
Secure Web Portal
Can I submit claims directly on the Web?
Yes, the system provides functionality to support real-time claim processing via the Secure Web Portal.
Can a claim be adjusted or voided on the Web?
Yes, a paid claim may be adjusted or voided using the Secure Web Portal and the interactive online claim functionality.
How long does it take for a claim to process when submitted on the Web through Direct Data Entry (DDE)?
Claims submitted on the Secure Web Portal through 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.
Are historical Remittance Advices (RAs) available in the Secure Web Portal?
Yes. Providers can access three months of RA history on the Secure Web Portal.
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 providers' 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.
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 Secure Web Portal?
The Florida Medicaid Management Information System (FMMIS) manages Electronic Data Interchange (EDI) services on a Secure Web Portal. Each provider (including 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 transactions 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 Secure Web Portal User Guide.
What do providers or authorized trading partners need to do to be able to access the Secure 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 on setting up an account, please see the Secure Web Portal User Guide.
When performing eligibility verification on the Secure 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.
How do you pull an existing claim in the Secure Web Portal to process an adjustment or void?
To pull an existing claim in the Secure 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.
How does the Secure Web Portal address verification functionality for hospitals work?
AHCA has implemented functionality available to hospital providers to confirm the accuracy of a recipient's current address at the time of admission. When performing an Eligibility Verification in the Secure Web Portal, a button is available titled "address verification." When used, the button returns results for the current residence address. This functionality is only available to hospital providers, and only on the Secure Web Portal.
What do I do if my password has expired?
For assistance with access to the Florida Medicaid Secure Web Portal, please call 1-800-289-7799, Option 5.
What do I do if I cannot access my Secure Web Portal account?
For assistance with access to the Florida Medicaid Secure Web Portal, please call 1-800-289-7799, Option 5.