Attention DME Providers-Recipients over the age of 21
When requesting authorization for a DME item please make sure you are referencing the Florida Medicaid Fee Schedule for the appropriate HCPCS Code. We have recently seen an increase of reviews submitted with the A9900 code. Please note A9900 is a -Misc DME Supply, accessory, and/or service component of another HCPCS Code .
(Example: briefs, diapers, protective underwear, pull-ons, liners, shields, guards, pads, wipes and undergarments)
You can reference the FL DME Imitations Handbook for additional information pp2-8.
PDN and PCS Providers
There have been recent changes to the Florida Medicaid Policy for Personal Care Services and Private Duty Nursing. You can find this policy by clicking on one of the links below.
FL Medicaid Coverage Policy for Personal Care Services
FL Medicaid Coverage Policy for PDN Services
One of the biggest changes is that you are now be able to request up to 180 days for all admission requests. Please make sure that if you are requesting 180 days that the prescription for services match your request.
Attention DME Providers
If you are entering a DME request please make sure you are referencing the Florida Medicaid Fee Schedule for Prior Authorization Requirements. If you do not have a copy of the Fee Schedule you can find them on our website on the following link.
Florida DME Fee Schedule
Prior Authorization numbers
When referencing the Fee Schedule if the code you are requesting has a “PA” this means the code requires prior authorization and once approved you will receive your authorization letter with a PA#.
If the code you are requesting only states “Medical Necessity” this means the code requires prior authorization however it does not require a PA #. This means a PA# will NOT generate when you receive your authorization letter. To avoid a denial on your claims make sure to include your authorization letter with your claim submission.
Submission Requirements for ADI and Outpatient Services
Untimely Authorization Requests
We wanted to remind you that all imaging and outpatient requests are required to be submitted as Prior Authorization. Until current we have been allowing and reviewing these cases. However, please refer to AHCA’s Authorization Requirements Coverage Policy. The only time Retrospective requests will be permissible is if the recipient has Retroactive Medicaid eligibility or as specified in the policy. Please note as of June 19th, 2017 we will be enforcing this policy and any cases with dates that have been submitted untimely will be cancelled.
We have recently seen an increase in “Pended” authorization requests for ADI. The current Coverage policy for ADI does not list specific documentation criteria. However AHCA’s Authorization Requirements Policy has specific criteria that we will be enforcing effective immediately.
Authorization Requirements Coverage Policy
To avoid a denial of your imaging request, please make sure to follow the submission requirements located under page 2 section 2.4 Submission Requirements. Failure to follow the stated requirements may result in denial of your request. Please make sure everyone within your organization who submits authorization requests are aware of these requirements.
As of March 1, 2017 The Fair Hearing Process has moved from being managed by DCF to now being managed by AHCA. The letters from eQHealth will be updated with the new information by the first of April until that time please be notified that the contact information for Fair Hearing is as follows:
You may ask for a fair hearing by contacting AHCA by telephone at (877)-254-1055, by fax at (239)-338-2642, in writing at, Agency for Health Care Administration Medicaid Hearing Unit P.O Box 60127 Ft.Myers, FL 33906 or by email at MedicaidHearingUnit@ahca.myflorida.com
Hospital UR Plans
PACWAIVER FAXED REQUESTS
The review process for 2017 UR PLANS has begun. We will review your submission, suggest any recommendations if needed and respond back with the results. If recommendations are made you will be afforded the opportunity to make any changes or corrections and resend the UR PLAN back in for review. Please note that the deadline for your submissions are May 31st 2017. Any submissions received after the deadline will not be reviewed. If you have any additional questions please contact firstname.lastname@example.org
Please note that as of April 10th, 2017, eQHealth Solutions will no longer be accepting faxed or emailed requests for PACWAIVER requests. These reviews will need to be entered in by your organization online via eQSuite.
INPATIENT & IMAGING FAXED REQUESTS
Please note that on August 1st, 2016, eQHealth Solutions will no longer be accepting faxed in inpatient or advanced diagnostic imaging requests. These reviews will need to be entered in by your organization or the respective provider via eQSuite online.
MULTISPECIALTY FAXED REQUESTS
Please note that as of October 15, 2016, eQHealth Solutions will no longer be accepting faxed in multispecialty requests. These reviews will need to be entered in by your organization or the respective provider via eQSuite online.
If you would like assistance regarding entering in review requests via eQsuite, please refer to our online User Guide for assistance. If you have questions, please contact Provider Outreach at PR@EQHS.ORG.