If you need help with your complaint, please call the toll-free member phone number listed on your member ID card. Billing and Claims | Sunshine Health This communication provides a general description of certain identified insurance or non-insurance benefits provided under one or more of our health benefit plans. We do not guarantee that each provider is still accepting new members. Attention Deficit Hyperactivity Disorder (ADHD). Suwannee, A minimum one-year, initial contract period may be required for some dental and vision plans, excluding Dental Savings Plus. This is not a complete list. On Oct. 1, 2021, our Staywell name will go away and you will become a Sunshine Health Long Term Care member. For information in alternate languages, please select the appropriate plan name link below. In states, and for products where applicable, the premium may include a $1 administrative fee. Humana Healthy Horizons in Florida Medical Plan Hernando, ${plan_name} complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. The Medicaid application and associated paperwork helps officials determine who is eligible for Medicaid coverage. WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States. Humana Individual dental and vision plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or Humana Health Benefit Plan of Louisiana, Inc. Discount plans offered by HumanaDental Insurance Company or Humana Insurance Company. Featuring benefits with copays as low as $0 and peace of mind for South Florida Medicare beneficiaries. We have good news. Staywell Health Plan is Joining Sunshine Health! Agency for Health Care Administration The Florida Medicaid application form requires you to give a lot of details . We want your claim submissions processed as efficiently as possible. The benefit information provided is a brief summary, not a complete description of benefits . The benefit information provided is a brief summary, not a complete description of benefits. Frequently asked questions Click here to create a FL Medicaid Member Portal account and send a secure message. Influenza, commonly called the flu, is a serious illness that can spread easily. Centene Monday - Friday. The appeal process does not promise acceptance into the program, but does give you a second opportunity to be enrolled. Box based on date of service guidance below. Humana Healthy Horizons will have the same benefits we offer today PLUS more. Your health information is kept confidential in accordance with the law. In the event of a dispute, the policy as written in English is considered the controlling authority. We are required by law to let you know that the Notice is available, and how you can get a copy of it. If billing a professional submission with services spanning before and after Oct. 1, 2021, please split the services into two separate claim submissions as outlined below. 800-322-2759 extension 1500290 (TTY: 711) For New Mexico residents: Insured by Humana Insurance Company. Nassau, Limitations, co-payments and restrictions may apply. Create your enrollment by filling out the Provider Information, Contact Information, Bank Information (only if adding EFT enrollment(s)), and Enrollment Information. 24 hours a day, 7 days a week. Process and decide claims within 30 days of receipt This includes: Processing clean payments for professional and institutional claim submissions, Process and decide claim reconsiderations within 120 days of the resolution date on the original (clean) claims EOB, Identify a Coordination of Benefit (COB) resubmission as a claim previously denied for other insurance info, or originally paid as primary without coordination of benefits, Process and decide COB claim reconsiderations within 95 days from the disposition date on the primary carriers EOB or response letter, Reduced manual posting of claim payment info, which saves you time and money, while improving efficiency, No need for paper Explanation of Benefits (EOB) statements. Find Covid-19 Information for Members and Providers. Looking for the federal governments Medicaid website? We aim to help improve the health and well-being of children and adults across the state, while helping you provide quality care. Medicaid provides healthcare coverage for income-eligible children, seniors, disabled adults and pregnant women. The Medicaid MMA & LTC plan specialists can answer questions and help you enroll. Guidelines for proper claims submissions | Sunshine Health Our M*Plus (MMA) plan is for pregnant women, children and adults who meet income requirements. For Texas residents: Insured or offered by Humana Insurance Company, HumanaDental Insurance Company or DentiCare, Inc (d/b/a Compbenefits). Call Floridas enrollment broker to enroll, disenroll, or ask questions: 1-877-711-3662 (TTY: 711). Clay, Data rates may apply. If you have any questions, please contact the EDI Department at the email address below. For information on local resources and community and supportive services in your area Find the contact information you need to get in touch. Please be sure to submit all five pages of the attestation. Completed and signed attestations can be submitted by the physician to the Department of Health via secure email at CMS.ClinicalEligibilityScreening@flhealth.gov or via fax to 850-488-3813. Billing and Claims | Sunshine Health Billing and Claims Please see the Provider Billing Manual and Billing Quick Reference Guides (QRGs). You can file claims with us electronically or through the mail. Password Resets. 800-477-6931 (TTY: 711) NARRATOR: As of April 1 2021, Humana Florida Medicaid will change its name to Humana Healthy Horizons in Florida. Download the free version of Adobe Reader. Enrollees will have 90 days after enrollment to choose a different plan. Email FLMedicaidResolution@humana.com, 800-229-9880 (TTY: 711) After filling out the form, you can be mail, fax or deliver the application in person. Copyright 2022 ${plan_name}. And improve payment turnaround time, so you can save time and effort. Limitations, copayments, and/or restrictions may apply. Learn more here. Serving all of Florida since 2002. After submitting their Medicaid application, most applicants will receive information about their enrollment status in about a months time. You get to keep the same great benefits, plus get more benefits from Sunshine Health. If youre affected by a disaster or emergency declaration by the President or a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you. Have a question for us or need support? It is funded by both the state and federal governments. Have questions? WellCare Health Plans Medicaid Office Location Florida Agency for Health Care Administration 2727 Mahan Drive Tallahassee, FL 32308 Medicaid Office Phone Number The phone number to call the Florida Medicaid office is 888-419-3456. Individuals can also report potential inaccuracies via phone. 1. View plan provisions or check with your sales representative. Limitations, copayments, and/or restrictions may apply. If you dont want to leave our site, choose the X in the upper right corner to close this message. For paper claims, please submit to Vivida at the following address: Vivida Health We provide free services to help you communicate with us. Medicaid Online To view the website for Florida Medicaid online, click here. Florida Medicaid Filing Services, Inc. . of Health and Human Services. From time to time, Wellcare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. Centene Completes Acquisition of WellCare, Creating a Leading Healthcare Enterprise Focused on Government-Sponsored Healthcare Programs, PR Newswire (January 23, 2020). , . Hillsborough, Do you or someone you know have Medicaid and Medicare? Florida Medicaid. You can file a claim reconsideration by mail: Mail your claim adjustment request/claim reconsideration form and all supporting documents to: All ABHFL EFT/ERA Registration Services (EERS) are managed by Change Healthcare. This policy has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. Find the documents and forms you need, including your member handbook. Offer not available on the following items: photo orders, prescriptions, tobacco, dairy, alcohol, liquor departments, phone/prepaid/gift cards, money orders/transfers, transportation passes, lottery tickets, charitable donations, pseudoephedrine or ephedrine products, newspapers, magazines, stamps, home medical equipment and durable medical equipment products, pharmacy items and services, Prescriptions Savings Club membership fee, and items or services submitted to insurance for reimbursement or where otherwise limited by law. Baker, UnitedHealthcare Health & Home Connection is a coordinated care management program for community-based elderly who are at risk of nursing home placement. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability. At AmeriHealth Caritas Florida, we recognize that our providers want to receive payment in a timely manner. From time to time, Wellcare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. Florida Medicaid Fair Hearing. We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. The benefits of an ERA include: To enroll in EFT/ERA Registration Services (EERS) visit Change Health payer enrollment services website. More information on eligibility and enrollment can be found on theFlorida Medicaidwebsite. Claims Resources for Providers - Humana Box 195560 San Juan, PR 00919-5560 Payment integrity & disputes Here are some resources for people with Medicaid and Medicare. BEWARE: The Supreme Court of Florida, in an effort to protect the elder public against these predators, has recently ruled that it is unlawful for non-attorneys to advertise, advise, draft documents, and, in general, to advise "customers" to become Medicaid/VA benefit eligible. For inpatient claims, the date of service refers to the members discharge date. Prospective applicants wondering where to apply for Medicaid in FL may be surprised about the methods and locations available for signing up for government assistance. Failure to follow these instructions may result in eligibility rejections. I understand that my information will be used in accordance with my plan notice of privacy practices. Florida DOH partners with WellCare of Florida (WellCare) to operate the CMS Health Plan. Be responsible for a child 18 years of age or younger,or, Have a disability or a family member in your household with a disability,or. Volusia. Claims coding Claims payment policies Staywell Health Plan (Staywell) provides health care and long-term care services to people who qualify for Florida Medicaid. Citrus, For paper claims, please submit to Vivida at the following address: Vivida Health PO Box 211290 Eagan, MN 55121 The benefits of submitting EDI claims include: Improved cost effectiveness Improved claims tracking Electronic acknowledgment of claim receipt Faster payment of claims Better turnaround time for timely reimbursement Interim Inpatient hospital bill should be billed with the following: For questions concerning this process, please call Provider Services at 844-243-5175 or email [emailprotected]. Already a member? Provider Billing Manual - Florida Medicaid & Health Insurance Box 14165 Lexington, KY 40512-4165 In Puerto Rico, please use this address: Humana Inc. Unidad de Querellas y Apelaciones P.O. Or choose Go on to move forward. Monday Friday, 8 a.m. 5 p.m., Eastern time, Humana Florida Healthy Horizons in Florida Long-Term Care Plan For Arizona residents: Insured by Humana Insurance Company. Please click on the links below to find out more about each plan, including benefits. We can help. What is the claims mailing address for Florida Medicaid? Bradford, Or choose Go on to move forward. Region 1: Escambia, Okaloosa, Santa Rosa and Walton counties, Region 2: Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla and Washington counties, Region 3: Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union counties, Region 4: Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties, Region 6: Hardee, Highlands, Hillsborough, Manatee and Polk counties, Region 7: Brevard, Orange, Osceola and Seminole counties, Region 8: Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties, Region 9: Indian River, Martin, Okeechobee, Palm Beach and St. Lucie counties, Region 11: Miami-Dade and Monroe counties. If you dont want to leave our site, choose the X in the upper right corner to close this message. Humana Medical Plan Inc. is a Managed Care Plan with a Florida Medicaid Contract. Is Sunshine Health and Staywell the same? Resources and Important Telephone Numbers, Electronic acknowledgment of claim receipt, Better turnaround time for timely reimbursement. Choose your eye doctor by calling: Other ways of finding an ophthalmology provider include: Call our central Behavioral Health line Please review plan details to learn more. Providers and Agents. Valuable information and tips to help those who care for people with both Medicaid and Medicare, Medicaid (This fee is non-refundable as allowed by state).

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