Please be advised that health plan expansion requests received after June 1, 2012, are not likely to be fully reviewed and approved prior to the release of the procurement documents for Statewide Medicaid Managed Care.

For the Miami-Dade and Statewide Prepaid Dental Contracts, please go to the PrePaid Dental Health Plans page at Prepaid Dental Health Plans Contracts and Templates.

2012-2015 Medicaid Health Plan Contract:

The final documents below make up the model contract upon which the September 1, 2012 – August 31, 2015 Medicaid health plan contracts are based. These contract documents are used for both Reform and non-Reform HMO and PSN contracts.  

Attachment I - FFS (130KB, PDF) Effective September 1, 2013
Attachment I - Capitated (185KB, PDF) Effective September 1, 2013
Attachment II (1.33MB, PDF) Effective Effective September 1, 2013
Attachment II - Exhibits (419KB, PDF) Effective September 1, 2013

2012-2015 Health Plan Report Guide (Effective 1/1/2014)

Health plan reporting specifications for all contract-required reports are provided in the 2012–2015 Report Guide.  The 2012–2015 Report Guide and report templates (Heading: "Contract Required Forms, Templates and Instructions") are located below.  The latest revised version of the guide is shown with its effective date, along with a Report Guide Revisions Transmittal, and a summary of changes made to the original document. Red-lined versions identifying changes are not posted but are available upon request.  When the latest guide takes effect, the prior version will be moved to history.  Plans may submit reports/report files using the information in the newest guide prior to its effective date where possible.   Report Guide changes are generally posted on a quarterly basis. Changes in report website links or templates may occur between Report Guide postings. If these do change, the report template link in the Report Guide may not work. If the Report Guide template links do not work, please use the template links provided under the heading "Contract Required Forms, Templates and Instructions" below.

Report Guide (2.17MB, PDF) Effective January 1, 2014
Report Guide Revisions Summary (369KB, PDF) Effective January 1, 2014
Report Guide Transmittal (246KB, PDF) Effective October 1, 2013

2012-2015 Health Plan Report Guide

Health plan reporting specifications for all contract-required reports are provided in the 2012-2015 Report Guide. The 2012-2015 Report Guide and report templates are located below. The latest revised version of the guide is shown above with its effective date, along with a Report Guide Revisions Transmittal, and a summary of changes made to the original document. Red-lined versions identifying changes are not posted but are available upon request. When the latest guide takes effect, the prior version will be moved to history.  Plans may submit reports/report files using the information in the newest guide prior to its effective date where possible.

2012-2015 Current Report Guide Version:

Report Guide (2.54MB, PDF) Effective October 1, 2013

Contract Required Forms, Templates and Instructions

Templates:
Audited Annual and Unaudited Quarterly Financial Reports  (441KB, XLS) 2014, *Updated 2/20/14
Behavioral Health – Critical Incident Report - Individual (21 KB, XLS)
Behavioral Health – Critical Incident Report - Summary (59 KB, XLS)
Behavioral Health – Enrollee Satisfaction Survey Summary (38 KB, XLS)
Behavioral Health – Required Staff-Providers Report (60 KB, XLS)
Behavioral Health – Stakeholders’ Satisfaction Survey Summary (47 KB, XLS)
BMHC Code 15 - Critical Incidents Report (31KB, XLS) Updated 3-4-2014
BMHC Critical Incidents Report (37KB, XLS) Updated 1-8-2014
BMHC Critical Incidents Report Summary Final (140KB, XLS)
CHCUP (CMS-416) & FL 60% Screening   (230KB, XLS)
Claims Aging Report & Supplemental Filing Report Capitated Health Plans   (2.45MB, XLS)
Claims Aging Filing Report Fee-For-Service PSNs  (2.02MB, XLS)
Community Outreach Health Fairs Public Events Notification  (142 KB, XLS)
Community Outreach Representative Report  (43 KB, XLS)
Complaints, Grievances, and Appeals Report (1.26MB, XLS)
Customized Benefit Notifications Report (37 KB, XLS)
Hernandez Settlement Agreement Log  (217 KB, XLS)      
Hernandez Settlement Agreement Survey (25 KB, XLS)
HIV-AIDS Algorithm Detail 03-06-09  (1491 KB, XLS)  
Insolvency Protection Multiple Signatures Agreement Form (107 KB, PDF) Updated 3-24-14
Medicaid Redetermination Notice Summary Report (40 KB, XLS)
Medical Loss Ratio Report  (67KB, XLS) Updated 1-29-2014
MCO Subcontractors and Affilates Report 09-20-12   (646 KB, XLSX)  
MPI Annual Fraud and Abuse Activity Report 03-12-12   (903 KB, XLSX)  
Naming Convention for Navigator  (36 KB, PDF)
Navigator Plan Files Questions & Answers 12-08-09 (95 KB, PDF)
Synopsis of the Navigator for Reform Choice Counseling (32 KB, PDF)
Newborn Enrollment Report (19 KB, XLS)
PCP Fee Increase Encounter Data File Layout (261KB, PDF)
PCP Fee Increase Summary Information (25KB, XLSX)
PCP Wait Times Report  (1.70 MB, XLS)
Performance Measures  (52 KB, XLS)
Provider Network File Layout  (357 KB, PDF)  Updated 9/20/12
      Specialty List (109 KB, PDF)
Provider Termination & New Provider Notification Report 12-15-09  (67 KB, XLS)
Rx Quarterly Submissions Proprietary Format Data Layout  (45 KB, DOC)
Rx Quarterly Submissions NCPDP Format Data Layout  (46 KB, DOC)
Rx Quarterly Submissions Data Certification  (35 KB, DOC)


Forms:
Involuntary Disenrollment Request Form (74 KB, XLS)  
Behavioral Health 80/20 Refund - contact the Bureau of Managed Health Care at 850-412-4300
Health Plan Redetermination Date Reminder (7 KB, PDF)
Redetermination Date File Usage Form (69 KB, PDF)
Provider Network Checklist  (91 KB, DOC)
Medicaid Health Plan Provider Network Spreadsheet  (113 KB, XLS)
Florida Health Plan Export File Format (570 KB, PDF) Effective 1/2013
Florida Health Plan Export File Formats (450KB,PDF) Effective 10/1/13
Sample Letter of Delegation  (41 KB, PDF)
MPI Subcontract Checklist Jan2011 (56 KB, XLS)
Provider Preventable Conditions - PPC (46KB, PDF)

Capitation Information:
Medicaid Non-Reform Capitation Rates FY1213 (229KB, PDF)
Medicaid Reform Capitation Rates Effective Sept 2012 (156KB, PDF)

2014 Policy Transmittals:
14-01 Pharmacy Encounter Data Validation Study (72KB, PDF) 2-13-14
14-02 PCP Ad Hoc Reporting (186KB, PDF) 2-17-14
14-03 0510 Codes-Reimbursement (309KB, PDF) 4-1-14
14-04 PDHP Dental Utilization Data (175KB, PDF) 3-20-14

2014 Health Plan Letters:
Enhanced Benefits Account Program Phase Out (123KB, PDF) 1/2/2014
Provider and Enrollee Transition Notices 2-10-2014 (236KB, PDF)
           Provider Notice Template (175KB, PDF)
           Enrollee Notice Template (173KB, PDF)
Transition Notices - Revised Webinar Dates (146KB, PDF) 2-21-14

Provider Service Networks (PSNs)


MEDICAID REFORM CONTRACT INFORMATION

Prior Medicaid Managed Care Health Plan Information:

For historical and informational purposes the 2012-2015 Contract and associated files are archived as updates/changes are made.

2009-2012 Medicaid Managed Care Contract, Report Guide, Templates and Forms - Archives

Prior HMO Contracts, Capitation Rates and Related Information - Archives

Prior Health Plan Policy Letters - Archives

Transmittal Archives:
2013 Policy Transmittals Archive

2012 Policy Transmittals Archive
2011 Policy Transmittals Archive
2010 Policy Transmittals Archive
2009 Policy Transmittals Archive
2008 Policy Transmittals Archive
2007 - no Policy Transmittals issued
2006 Policy Transmittals Archive
2005 Policy Transmittals Archive
2004 Policy Transmittals Archive
2003 Policy Transmittals Archive
2002 Policy Transmittals Archive (86.5 KB, PDF)
2001 Policy Transmittals Archive
2000 Policy Transmittals Archive
1999 Policy Transmittals Archive

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Reporting Medicaid Fraud