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Medicaid HMO Provider-Related Information

Forms:
Involuntary Disenrollment Form
Mulitple Signature Agreement Form (Insolvency Account)
Behavioral Health 80/20 Refund - contact the Bureau of Managed Health Care at
850-487-0640

2009 Templates:
Financial
Grievance and Appeals
HMO Claims Aging                   PSN Claims Aging
Child Health Check-UP (2007-2008)
Community Outreach Event Log
Community Outreach Representatives Log (Update 4/13/09)

Contract Information:

MEDICAID REFORM CONTRACT INFORMATION

SPECIAL NOTE:   The 2006-2009 HMO Medicaid Contract begins September 1, 2006 and is a three (3) year contract.

Medicaid HMO Contract 2006-2009 (Pdf files)

Standard Contract - Section IV Amendment (March 2009)

Amended Contract: (December 2007)
     Standard Contract
     Attachment I: Scope of Services
     Attachment II: Online with Interactive Table of Contents (General Contract)
     Attachments III - V were not amended
     
Original Contract
    Standard Contract
    Attachment I: Scope of Services
    Attachment II: Online with Interactive Table of Contents (General Contract)
    Attachment III: Business Associate Agreement
    Attachment IV: Lobbying
    Attachment V: Debarment Form

Medicaid Prepaid Dental Health Plan Contract:

Standard Contract
Attachment I: Scope of Services  
Attachment II: Business Associate Agreement
Attachment III: Lobbying
Attachment IV: Debarment Form
Attachment V: Subcontractor Utilization Report Form

            NOTE: Please be advised that the online version of the 2006-2009 Medicaid Prepaid Dental Health Plan Contract will not contain general amendments. As a general amendment is posted it should be printed and incorporated into the contract.

Medicaid Prepaid Dental Health Plan Templates
CHCUP-Dental 60%-0708
Dental Health Checkup-0708

2009:
Financial
Enrollee-Dental-User
FQHC Report
Grievance & Appeals
Incentive-Distribution
Service Utilization

Prior Contracts:

HMO:
PRE-PAID DENTAL:
Medicaid HMO Contract 2004-2006 Medicaid Pre-Paid Dental 2004-2006
Medicaid HMO Contract 2002-2004  
Medicaid HMO Contract 2000-2002  
Medicaid HMO Contract 1998-2000  

Capitation Information

Medicaid HMO Capitation Rates for 2008-2009 Contract Year
Medicaid HMO Capitation Rates for 2007-2008 Contract Year
Medicaid HMO Capitation Rates for 2006-2007 Contract Year
Medicaid HMO Capitation Rates for 2005-2006 Contract Year
Medicaid HMO Capitation Rates for 2004-2005 Contract Year
Medicaid HMO Capitation Rates for 2003-2004 Contract Year
Medicaid HMO Capitation Rates for 2002-2003 Contract Year
Medicaid HMO Capitation Rates for 2001-2002 Contract Year
Medicaid HMO Capitation Rates for 2000-2001 Contract Year
Medicaid HMO Capitation Rates for 1999-2000 Contract Year

Medicaid Coverage and Limitation Handbooks
 Medicaid Provider Reimbursement Handbooks

All provider handbooks are available online on the Consultec web site.

Agency Notification Letters -
Please go to MEDICAID REFORM CONTRACT INFORMATION for Agency Notification Letters (Dear Health Plan).

2008

Description: Date:
 Request for Benefit Information Cards  5-14-09
   


Policy Transmittals -
Please go to MEDICAID REFORM CONTRACT INFORMATION for Reform Policy Transmittals.

2008

Description
Date
 08-05 Non-Reform Performance Measures, FARS/CFARS Reporting  04/30/08
 08-06 Notice of Discontinuation of Provider Default ID Usage  04/28/08
 08-08 Unborn Activation Process  12/12/08
       08-08 Unborn Activation Attachment #1  12/12/08
       08-08 Unborn Activation Attachment #2  12/12/08
       08-08 Unborn Activation Attachment #3  12/12/08


NOTE: Please note that the Reform contract and the 08-05 Non-Reform policy transmittal contain an error in the e-mail address to submit performance measures reports.  In the reporting instructions contained in attachment B of the 08-05 policy transmittal as well as Section XII. I. 2.g. Reporting Instructions for the Performance Measures Report of the Medicaid HMO Reform Contract, the correct email address should be MRPM@ahca.myflorida.com.

2007

Transmittal Archives:

2006 Policy Transmittals Archive
2005 Policy Transmittals Archive
2004 Policy Transmittals Archive
2003 Policy Transmittals Archive
2002 Policy Transmittals Archive
2001 Policy Transmittals Archive
2000 Policy Transmittals Archive
1999 Policy Transmittals Archive

Fee Schedules

Current and past fee schedules for all Medicaid services can be found on the Consultec Internet site.
Title XXI Immunizations

In June of 1999, Policy Transmittal 99-03 described the Vaccines for Children Program (VFC) and its relationship to Title XXI Medikids. This policy statement also addressed billing options. In May of 2001, a revision was published in Policy Transmittal 01-07. Now there is only one billing option: Direct service providers must bill Medicaid fee-for-service. For a copy of the reimbursement rates that apply when providers supply immunizations to Medicaid HMO-enrolled MediKids, access the document titled Immunization Codes for HMOs, HCPCs 2001. You will also find other useful information at this MediKids Publications site.

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