Provider Alert from the Agency For Health Care Administration:
Important Upcoming Policy Change Reminder: New and Enhanced Self-Service Web Portal Features FL Medicaid Policy Change Reminder (Click Here)
Attention Dental Providers:
Dental Services has transitioned to SMMC Dental Program, effective 2/1/19. For additional information, please visit the Agency’s website for information on Florida Medicaid’s Dental Changes : FL Medicaid Dental Announcement
Behavior Analysis Providers:
Untimely Authorization Requests:
This is a reminder that Behavior Analysis Services are to be submitted as Prior Authorization. Any cases submitted for dates of service that are not current are considered untimely and will be cancelled. Please refer to our Phase 2 Provider Training, Page 40 and 43. You can also refer to AHCA’s Authorization Requirements Coverage Policy Bullet 2.0 via the following link FL Medicaid Authorization Requirements Policy Retrospective requests will be permissible if the recipient has Retroactive Medicaid eligibility or as specified in the policy.
2.0 Authorization Requirements
2.1 When to Request Authorization
- Providers must obtain authorization prior to rendering Florida Medicaid-covered services, except in an emergency, when:
- Specified in the service-specific coverage policy or the applicable Florida Medicaid fee schedule(s).
- Services will be performed out-of-state.
Thank you in advance for your cooperation.
Hurricane Michael Provider Alert from the Agency For Health Care Administration:
Hurricane Michael Provider Alert (Click Here)
Attention Home Health Providers:
This is an update to the Home Health Services Electronic Visit Verification (EVV) Florida Medicaid Health Care Alert, Dated August 28, 2018. The details of this update are located via the link below.
Home Health Services (EVV) Update
Attention Behavior Analysis Service Providers:
When submitting prior authorization requests for BA services, providers must submit ALL materials to eQHealth as specified in Appendix 9.0 of the Behavior Analysis Services Coverage Policy. If eQHealth determines that the submission is incomplete or contains insufficient documentation to make a decision, it will inform the provider. The provider then has two business days to submit the remaining materials and/or documentation before the request is denied for lack of documentation. The provider can resubmit a complete authorization request at any time.
When requesting prior authorization for BA services, providers must submit one of the following types of comprehensive evaluations:
- Individualized Education Program (IEP)
- Evaluation by the recipient’s school district that has determined eligibility for special education
- Diagnostic evaluation conducted by one of the following:
- Developmental pediatrician licensed in accordance with Chapter 458, F.S. and certified by the American Board of Pediatrics
- Clinical psychologist licensed in accordance with Chapter 490, F.S.
- Child and adolescent psychiatrist licensed in accordance with Chapter 458, F.S. and certified or eligible for certification by the American Board of Psychiatry and Neurology
A complete request must include the recipient’s diagnostic evaluation report that contains clinical findings, recommendations, and a diagnosis. All submitted documentation must meet the requirements in accordance with Appendix 9.0 of the Behavior Analysis Services Coverage Policy (Rule 59G-4.125, F.A.C.).
FL Medicaid Behavior Analysis Services Information