2020 Page 2 of 136. secure provider portal: https://provider.wellcare.com . Section 4: Utilization Management (UM), Case Management (CM) and Disease Management (DM) Utilization Management Overview Medically Necessary Services Criteria for UM Decisions Utilization Management Process Florida Medicaid Provider Manual Effective November 20. 3 Contents ... to establish the Florida Medicaid program as a statewide, integrated managed care program for all ... reimbursement can be found in the AHCA Medicaid handbook and fee schedules. It must be used in conjunction with the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, which contains information about specific procedures for submitting claims for payment, *i� Florida Medicaid Provider Manual Effective August 31, 2020 Page 5 of 136 secure provider portal: https://provider.wellcare.com 2020 Florida Medicaid Provider Manual Table of Revisions Date Section Comments Page Change 8/31/2020 Section 5: Claims 275 Claim Attachment Transactions via EDI 70 Added new section We would like to show you a description here but the site won’t allow us. Providers, Hospitals and Ancillary Providers (collectively, Providers). This rule applies to providers rendering Florida Medicaid services to recipients. Mental Health Florida Medicaid Community Behavioral Health Services … 2017 MEDICAID PROVIDER HANDBOOK. Magellan Complete Care of Florida . • Coverage and limitations handbooks explain covered services, their limits, who is eligible to receive them, and the fee schedules. 13 (2) Florida Medicaid reimburses for services rendered in the fee-for-service delivery system based on a fee schedule, cost report, or contract. legislative claim bill manual – The Florida Senate. file, and proceed. { �m�m��Vv/��9@6;��G�����/dTc"1�;�'\L�� �6"4�5eS[,�q��k' � �Z&��,�{���(e7��Bƴ&dD.//6��S��S�-�C�� &�����PC�n�61��6vp;��:��* �-;ZgРQ���T�$N�����? Thisinformation is �A��d��E���ɐ�'4�R}ia�D%"K`�V)d��D�a�ZI�b�����ƀ�P�@ؔ^�ʁF�X X0����А�c�֐\$��!������I� X���6Bf~�� �9�W%@C`O�$Bj��&��a@r�Ғl[z��̱BH.rX�B�SiB�Ẵ�+���خ�)4�fB)MO�P��0��2��1�c D������'�\�aؤ�;%Y޹9���'>V�*��i��{��+�. 2020 Provider Handbook . Reimbursement Policies and Fee Schedules - Rules pertaining to submitting claims for reimbursement and reimbursement methodologies. endstream endobj 3343 0 obj <>stream Background There are three types of Florida Medicaid handbooks: • Provider General Handbook describes the Florida Medicaid Program. Ec� The Manual replaces and supersedes any previous versions dated prior to August 31, 2020, and is available on WellCare’s website at www.wellcare.com/Florida/Providers/Medicaid. Revised CMS-1500 Claim Form (front). WellCare serves approximately 6.4 million Members. hޜԻN�@�_�?��c_R���&��E$"D�G����;�"����xvw&��)�j�ҮJ��#ai!��i�!�� CMS Plan follows the Florida Medicaid handbooks and pay according to the Florida Medicaid fee … VERSION XLV EFFECTIVE DATE June 2, 2020 . July 2008. �zׇ�dd��d�Fc���~��g�>N��4��l@�+�PUGu ���;����>gl�;F�8^�? in conjunction with the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, which contains information about specific procedures for submitting claims for payment, and the Florida Medicaid Provider General Handbook, which describes the Florida Medicaid program. Florida Relay 711 or TTY 1-800-955-8771. Clinical Monitoring, Ambulatory Surgical Center Services Fee Schedule, Behavioral Health Overlay Services Fee Schedule, Child Health Targeted Case Management Services Fee Schedule, Community-Based Substance Abuse County Match Fee Schedule, Community Behavioral Health Services Fee Schedule, County Health Department Certified Match Program Fee Schedule, Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients, Medicaid Certified School Match Program Fee Schedule, Medical Foster Care Services Fee Schedule, Mental Health Targeted Case Management Services Fee Schedule, Occupational Therapy Services Fee Schedule, Prescribed Drugs Immunization Fee Schedule, Prescribed Drugs Oncology Physician Administered Fee Schedule, Prescribed Drugs Physician Administered Fee Schedule, Prescribed Pediatric Extended Care Services Fee Schedule, Private Duty Nursing Services Fee Schedule, Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule, Regional Perinatal Intensive Care Center (RPICC) Obstetrical Services Fee Schedule, Specialized Therapeutic Services Fee Schedule, Speech-Language Pathology Services Fee Schedule, Targeted Case Management for Children at Risk of Abuse and Neglect Services Fee Schedule, Federally Qualified Health Center Billing Codes, Hospital Outpatient Services Billing Codes, Intermediate Care Facility for Individuals with Intellectual Disabilities Services Billing Codes, Statewide Inpatient Psychiatric Program Services Billing Codes.