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Dear Medicaid partner: We are always looking for ways to work with you better. Over the last year we have been asking providers across the state how we can improve our practices, and we have been working to implement your recommendations. One of those ideas was to improve the ways we communicate with you, and this month we're upgrading our electronic Provider Bulletin. We hope this new format will be easier to read and will allow you easy access to the information you need. Once you review it, will you let us know what you think? Please send your suggestions to ahcacommunications@ahca.myflorida.com. In addition, we want to make sure that we have the most up-to-date technology in order to ensure that you are paid in a timely manner. On July 1st we will be switching to our new Fiscal Agent, and we hope that that will allow for even faster claims payment. We have done considerable outreach to make sure the transition is a smooth one, but just in case you have questions once we go live, we will have teams standing by at 800-289-7799, Option 7. Your service matters to us, and we hope that we will continue to serve you well. Thank you for all that you do to serve the patients of Florida, and thank you for your help with our mission to help more Floridians find access to affordable, quality health care. Sincerely,
All Providers:New Contact Information Available for Florida Medicaid With the implementation of the new Florida Medicaid system (Medicaid Management Information System/Decision Support System – FMMIS/DSS), most contact information for providers and beneficiaries with the fiscal agent will remain the same. EDS will assume responsibility for many P.O. Boxes and telephone numbers previously associated with ACS. For the full story... Medicaid Starts Comprehensive Hemophilia Disease Management Program Florida Medicaid started the Comprehensive Hemophilia Disease Management program on April 1, 2008. Two specialty pharmacy companies— Caremark and Hemophilia of the Sunshine State (owned by Curascript) — are providing program services, which include: care management; physician and beneficiary education; 24/7 access to a toll-free nurse helpline; and dispensing of factor products, assay, and other hemophilia-related pharmaceuticals. For the full story... Medicaid Coverage Available for Non-Citizens Federal regulations allow states to reimburse for emergency services provided to Medicaid beneficiaries who are “non-citizens,” also referred to as “aliens,” on a limited basis. Aliens are not eligible for full Medicaid benefits due to their status as non-citizens. For the full story... Update on Medicaid’s Payment Error Rate Measurement Program This article is fifth in a series on the Payment Error Rate Measurement (PERM) program. The Improper Payments Information Act of 2002 (HR 4878) requires federal government agencies to estimate their improper payments annually. For the full story... National Provider Identifier (NPI) Issues The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the adoption and use of an NPI for all health care providers. The NPI replaces all identifiers, including Medicaid provider numbers, on HIPAA standard electronic transactions. As a Florida Medicaid provider, you must register your NPI with Florida Medicaid in order to establish a crosswalk between your NPI and your Medicaid Provider ID. If you have not registered your NPI with Florida Medicaid, you must do so in order to avoid any future disruption of payments. For the full story... A Note from the Inspector General The Office of Inspector General at AHCA has oversight of the Bureau of Medicaid Program Integrity. Title 42 CFR, Part 455, establishes the requirements for a state fraud detection and investigation program and for disclosure of information on ownership and control. For the full story... |
Practitioners:Medicaid Requires Use of National Drug Code Requirement Based on the Federal Deficit Reduction Act of 2006, Florida Medicaid requires the reporting of the 11-digit Submitting Medicare Crossover Claims for J3490 and J9999 This is only applicable for Medicare crossover claims with a J-code of J3490 or J9999. Once a drug is assigned a J-code, the correct J-code for that drug must be used and the claim sent to the Medicaid fiscal agent. Claims involving only Medicaid are sent to the Medicaid fiscal agent. For the full story... Commas Required as Diagnosis Pointers Always place a comma between the diagnosis pointers in section 24E. If there are three diagnoses that relate to a procedure, a comma should be placed between the pointer numbers 1 and 2 and 3, such as this: 1,2,3. Many Medicaid claims are currently being denied because of the missing commas. For the full story... |
Hospitals and Physicians:Transplant Global Billing Procedures Provides Higher Reimbursement Global reimbursement for transplants allows Medicaid to reimburse providers at a different or higher rate than fee-for-service reimbursement. Global reimbursements are paid to Medicaid-designated transplant facilities for adult heart, liver, lung, and pediatric lung transplants. For the full story... Labor and Delivery Services Undergo Expanded Review During the 2007 Special Legislative Session C, the Legislature passed Senate Bill 2-C, which required AHCA to expand the prior authorization requirements of labor and delivery services. For the full story... |
Physicians and Nurses:The Florida Discount Drug Card Offers Cost Savings The State of Florida now offers the Florida Discount Drug Card that offers eligible Floridians savings on drugs at more than 4,000 participating pharmacies. An easy-to-use website, www.FloridaDiscountDrugCard.com, is available to help consumers learn which drugs are discounted and find participating pharmacies. For the full story... |
Dentists:Reimbursing Procedure Codes DO145 and DO1206 Dental procedure code D0145 is an oral evaluation for a patient under three years of age and includes counseling with the primary caregiver. Procedure code D1206 is for the application of topical fluoride varnish and is a therapeutic application for moderate to high caries risk patients. For the full story... |
Home Health Agency:Prior Authorization for Private Duty Nursing and Personal Care Changes Recently, there have been changes to the prior authorization process for private duty nursing and personal care services through the Agency’s peer review organization, KePRO. For the full story... |
Behavioral Health and Managed Care:New Study of 2007-2008 Behavioral Health Prior Authorization Process The Florida Managed Care External Quality Review contract for Fiscal Year 2007-2008 includes a focused study on “Behavioral Health Prior Authorization Processes.” This study focuses on behavioral health outpatient services across Health Maintenance Organizations, Provider Service Networks, and Prepaid Mental Health Plans, collectively referred to as Managed Care Organizations. For the full story... |
Physicians, ARNPs, PAs, CHDs, Birth Centers, and Children’s Medical Services:Following Procedures for Multiple Gestations This link provides clarification on submitting codes for multiple gestations. For the full story... |
Physicians, ARNPs, PAs, and Podiatrists:New Claims System for Multiple Surgery Billing Multiple surgeries are separate procedures performed by a physician on the same patient during the same operative session or on the same day. Medicaid is programming the new claims processing system to price multiple surgery claims. This will reduce the requirements for paper processing in the future. For the full story... |
Physicians, County Health Departments, and Children’s Medical Services:Biophysical Profiles Required or Claim is Denied The Florida Medicaid Physician Coverage and Limitations Handbook requires all components of a biophysical profile documented in the report. All claims with reports without the detailed components will be denied with edit 909. For the full story... |
Physicians, ARNPs, PAs, RHCs, FQHCs, and CHDs:Reimbursing Fluoride Varnish Application Effective April 15, 2008, Medicaid will cover the application of fluoride varnish when provided to beneficiaries in a physician’s office. Physicians, physician assistants, and advanced registered nurse practitioners may provide this service and bill Medicaid for it using CPT procedure code 99499. For the full story... |
Child Health Check-Up (CHCUP):Critical Reminder to Child Health Check-Up Providers Performing a blood test for lead is a federal requirement at specific intervals during the “Child Health Check-Up.” Documentation is essential for the blood tests performed to be in compliance with this federal mandate. For the full story... |
