Provider Information Page

This page includes provider information regarding eligibility verification, claims submission, and payment. Please check periodically for updates to the Implementation web site. Providers are also encouraged to subscribe to the Florida Medicaid Email Alert system for timely, automatic email updates (see Email Alert Subscription Form navigation link above for more information).

Web Portal

The fiscal agent will be required to create a Web portal for provider applicants that will maintain information such as downloadable enrollment forms, claims and special billing forms, upcoming training announcements, field representatives’ names and phone numbers, recent remittance voucher banner messages, a hot link to the Agency Web site, and other material that would be useful to providers. Providers can expect a Web portal that allows access to Florida Medicaid information including:

• Enrollment application submission and processing;
• Provider training – to include provider training for the Web portal for provider enrollment, recipient eligibility verification, claims processing and general inquiries. In addition, provider training will include detailed information regarding processes for provider payment and adjustments, including explanation of remittance vouchers and Web-based inquiry regarding payment status;
• Provider handbook access;
• Provider billing instructions;
• Provider bulletins;
• Recipient eligibility verification;
• Claims submission and correction;
• Remittance vouchers;
• Payment status;
• Claim status; and
• Suggestions to resolve billing problems.

Non-portal Access

While the new system will take advantage of web portal technology, it will also continue to offer providers the same processes as the current system. For example, the fiscal agent must continue to operate several effective means for Medicaid providers to check a recipient’s Medicaid eligibility status. In addition to the Web portal, eligibility inquiries may be made by HIPAA electronic transaction, by pharmacy POS networks, through Medicaid Eligibility Verification System (MEVS) switch vendors, by an automated telephone system, to operators in telephone toll-free call centers operated by the fiscal agent, and by fax. Eligibility inquiries may be made individually or in a batch submission, in the appropriate format.

Recipient Access to the Web Portal

The Web portal will also give recipients their own secure access, providing them with online and real-time ability to view their personal data, request changes, request protected health information (PHI), and view claims filed on their behalf from providers. Recipients are expected to be able to use the Web portal to obtain or perform the following:

• Choice counseling information;
• Certificates of creditable coverage;
• HIPAA PHI requests;
• ID card replacement requests;
• View claims history;
• Report fraud and abuse; and
• View general Medicaid information and official notices.