Medicaid Program Oversight (MPO)

The mission of the Medicaid Program Oversight Unit (MPO) is to monitor, analyze and validate encounter data submissions from Medicaid Health Plans to enhance system processes for collecting and reporting encounter data, to determine Health Plans’ compliance with contractual requirements, and to measure health outcomes.  To that end, MPO collects, processes, stores, reports and analyzes the encounter data from managed care service activities and prescription drug utilization for all Florida Medicaid capitated Health Plans.  MPO also supports rate development and the risk model computations that set capitated payments for managed health care entities as defined in the Florida Medicaid Reform contracts.

The Agency for Health Care Administration is required to capture encounter data for all Medicaid managed care services in compliance with Title XIX of the Social Security Act, the Balanced Budget Act of 1997, 42 CFR 438, and Chapters 409 and 641, Florida Statutes.

Compliance Reports

Current Information

Archive

NCPDP

Related Links

 

HIPAA 5010 and NCPDP D.0 Encounter Claims Submissions

The Florida Medicaid Program now requires version 5010 of X12 837 encounter claims, and version D.0 of National Council for Prescription Drug Programs (NCPDP) encounter transactions.
X12 5010 Encounter Claims -

For example, here are some common errors/issues to be aware of:

NCPDP D.0 Encounter Claims -

Contact Information

Please contact the appropriate party for help in the following areas:

Email your comments and suggestions to:

MPOMAILBOX@ahca.myflorida.com

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