Medicaid Fiscal Agent Operations

Gay L. Munyon
Bureau Chief

2562 Executive Center Circle E
Montgomery Bldg., Suite 100
Mail Stop #22
Tallahassee, Florida 32301

Phone: (850) 412-3400
Fax: (850) 410-1430

The Bureau of Fiscal Agent Operations has oversight responsibilities for the Fiscal Agent provider enrollment, claims processing and payment, management of the the Florida Medicaid Management Information System (FMMIS) and the Decision Support System (DSS). 

Medicaid Enterprise System Procurement Strategy

On February 5, 2014 the Centers for Medicare & Medicaid Services (CMS) approved the Florida Medicaid Planning Advance Planning Document (PAPD) for the Agency for Health Care Administration (AHCA or Agency) to contract with consultants to provide research and planning, project management office (PMO), and independent verification and validation (IV&V) services to assist with the procurement of a new fiscal agent contract and enhancements to, or development of, the Florida Medicaid Management Information System (FMMIS) and Decision Support System (DSS)/Data Warehouse (DW).

Provider Enrollment

The bureau section provides coordination of Fiscal Agent provider enrollment functions, provider data maintenance, outreach, education, and issue resolution to providers, the Medicaid managed care plans, the Medicaid Regional Offices, and program operating partners at the Department of Health and the Agency for Persons with Disabilities.

Recipient File Management

The bureau section maintains integrity of recipient eligibility data in the FMMIS and provides oversight of Medicaid Fiscal Agent recipient file management functions.

Systems Maintenance

This bureau section develops, coordinates and monitors Customer Service Requests (CSRs) for System Maintenance performed by the Fiscal Agent, File Maintenance, Audits, Claims Reprocessing, Issue identification and Production Issues Resolution.

Systems Projects

This bureau section develops, coordinates, and monitors Customer Service Requests (CSRs) for System Projects performed by the Fiscal Agent, and oversee special projects. 

Special Projects/Project Management

This bureau section ensures compliance of the Florida Medicaid Management Information System (FMMIS) with federal and state regulations; develop federal Advance Planning Documents (APD) to receive approval for Medicaid system projects and enhanced federal funding, and develop state Legislative Budget Requests (LBR) for fiscal agent projects.

Finance and Banking Operations (FBO)

This bureau section is responsible for overseeing the management of and monitoring the financial and banking functions of the Fiscal Agent to ensure appropriate payment of Medicaid claims, including coordinating all federal IRS tax reporting efforts for payments made to providers.

Decision Support Systems

This bureau section monitors the Decision Support System (DSS) portion of the Fiscal Agent contract to ensure system availability, access and accuracy for authorized State users.  The DSS staff also assists users with building ad hoc queries, customized reports and large data extracts.

Compliance Reporting and Claims/Encounter Support

This bureau section is responsible for contract compliance reporting of all phases of the Medicaid Fiscal Agent’s operations. 

Reference Information

Resources Information

ICD-10

Currently, health care entities are required by Federal regulations to use a standard code set to indicate diagnoses and procedures on transactions.  For diagnoses, the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code set is used.  For inpatient hospital procedures, the ICD-9 procedure code set (PCS) is used.  Effective October 1, 2015, the standard code set that is required for diagnosis codes is changing to the ICD-10-CM and the standard code set that is required for inpatient hospital procedures is changing to the ICD-10-PCS. 

HIPAA EDI

More information for the Health Insurance Portability and Accountability Act (HIPAA) can be found at the HIPAA Compliance Office web page.

Electronic Health Records (EHR) Florida Medicaid Incentive Program