The purpose of the amendment to Rule 59G-4.001 is to incorporate by reference the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, ____________. The amendment clarifies and updates policy.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.001Medicaid Providers Who Bill on the CMS-1500

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.001, F.A.C., is to incorporate by reference the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, ____________. The amendment clarifies and updates policy.

SUBJECT AREA TO BE ADDRESSED: Medicaid Providers Who Bill on the CMS-1500.

An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-4.001 will have as provided for under Sections 120.54 and 120.541, Florida Statues.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.

A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: Tuesday, October 29, 2013, 3:00 p.m. to 4:00 p.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room D, Tallahassee, Florida 32308-5407

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Fred Lawrence at the Bureau of Medicaid Services, [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT IS: Fred Lawrence, Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail].

Please note that a preliminary draft copy of the reference material, if available, will be posted prior to the workshop at: http://ahca.myflorida.com/Medicaid/review/index.shtml

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

59G-4.001 Medicaid Providers Who Bill on the CMS-1500.

(1) This rule applies to aAll Medicaid providers and their billing agents who submit claims on behalf of an enrolled Medicaid provider who are enrolled in the Florida Medicaid program required by their service-specific coverage and limitations handbook or other notification by the Medicaid Program to bill the Florida Medicaid Program on a paper CMS-1500 claim form for reimbursement of services performed on a Medicaid eligible recipient, must be in compliance with the provisions of the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, July 2008, which is incorporated by reference.

(2) All providers and their billing agents, who submit claims on behalf of an enrolled Florida Medicaid provider, must be in compliance with the provisions of the Florida Medicaid Provider Reimbursement Handbook, CMS-1500,__________. The handbook is available from the Medicaid fiscal agent’s Web site Portal at www.http://mymedicaid-florida.com. Select Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. Paper copies of the handbook may be obtained by calling the Provider Services Contact Center at 1-800-[phone] and selecting Option 7.

(3)(2) The following forms that are included in the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, and are incorporated by reference: in Chapter 1, the CMS-1500 Claim Form, Approved OMB-0938-0999 Form CMS-1500, February 2012 (08-05), one page double-sided; and in Chapter 3, the Florida’s Healthy Start Prenatal Risk Screening Instrument, DH 3134, 2/01, one page; State of Florida, Florida Medicaid Authorization Request, PA01 07/08, one page; Medically Needy Billing Authorization, CDF-ES 2902, October 2005 June 2003, one page; Consent fFor Sterilizatioón, HHS-687, October 2012 (11/2006), doublesided; Consentimiento pPara lLa Esterilizacióon, HHS-687-1, November 2006 (11/2006), doublesided; State of Florida, Hysterectomy Acknowledgment Form, HAF, July 1999 07/1999, one page; State of Florida, Exception to Hysterectomy Acknowledgment Requirement, ETA, July 2008 07/2008, one page; State of Florida, Abortion Certification Form, AHCA-Med Serv Form 011, August 2001; and Help Your Baby Have a Healthy Start in Life!, DH 3134, April 2008; and, State of Florida, Medicare Part C – Medicaid, CMS – 1500 Crossover Invoice, AHCA Form 5000-3527, June 2012 one page. All the forms except for the Help Your Baby Have a Healthy Start in Life! Healthy Start Prenatal Risk Screening Instrument are available from the Medicaid fiscal agent’s Web site at by calling the Provider Contact Center at [phone] and selecting Option 7 or from its Web Portal at www.http://mymedicaid-florida.com. Select Click on Public Information for Providers, then on Provider Support, and then on Forms. Paper copies of the forms may be obtained by calling the Provider Services Contact Center at 1(800)289-7799 and selecting Option 7. The Help Your Baby Have a Healthy Start in Life! Form Healthy Start Prenatal Risk Screening Instrument is available from the local County Health Department.

Rulemaking Specific Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History– New 10-1-03, Amended 7-2-06, 3-7-07, 4-9-08, 12-3-08,____________.