The purpose of this rule amendment is to incorporate by reference the revised Florida Medicaid Provider General Handbook, January 2007. The major handbook revisions include updated information on Medicaid’s managed care plans, enrollment policy ...

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO: RULE TITLE
59G-5.020: Provider Requirements
PURPOSE AND EFFECT: The purpose of this rule amendment is to incorporate by reference the revised Florida Medicaid Provider General Handbook, January 2007. The major handbook revisions include updated information on Medicaid’s managed care plans, enrollment policy changes as a result of the National Provider Identifier (NPI), and the revised newborn enrollment policy for HMOs. In addition, the revised handbook includes policy clarifications and updated statutory references, definitions, and addresses and phone numbers.
SUBJECT AREA TO BE ADDRESSED: Provider Requirements.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: Monday, October 30, 2006, 10:00 a.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Bldg 3, Conference Room D, Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Karen Girard, Bureau of Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308, [phone]

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

59G-5.020 Provider Requirements.

(1) All Medicaid providers enrolled in the Medicaid program and billing agents who submit claims to Medicaid on behalf of an enrolled Medicaid provider must comply with the provisions of the Florida Medicaid Provider General Handbook, January 2007 October 2003, updated January 2004, which is incorporated by reference and available from the fiscal agent’s website at http://floridamedicaid.acs-inc.com agent. Click on Provider Support, and then on Handbooks agent. Paper copies of the handbooks may be obtained by calling Provider Inquiry at [phone].

(2) The following forms that are included in the Florida Medicaid Provider General Handbook are incorporated by reference: IRO5 07/2001, State of Florida, Provider Inquiry Form, Florida Medicaid Program; Temporary Emergency Medicaid Identification Form, January 2007 2004; CF-ES 2681, Feb 2003, Notice and Proof of Presumptive Eligibility for Medicaid for Pregnant Women; CF-ES Form 2014, Feb 2003, Authorization for Medicaid/Medikids Eligibility; Unborn Activitation Form, January 2007 2004; CF-ES 2039, Sep 2002, Medical Assistance Referral; CTEC-07, Revised 03/2003, Crossover with TPL Claim and/or Adjustment Form; and ACS Florida Medicaid Claims Order Form, January 2007 2004. The CF-ES forms are available from the Department of Children and Family Services. The other forms are available from the Medicaid fiscal agent’s website at http://floridamedicaid.acs-inc.com agent. Click on Provider Support, and then on Handbooks agent. Paper copies of the forms may be obtained by calling Provider Inquiry at [phone].

Specific Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History–New 9-22-93, Formerly 10P-5.020, Amended 7-8-97, 1-9-00, 4-24-01, 8-6-01, 10-8-03, 1-19-05,_________.