Fla. Admin. Code Ann. R. 59G-4.001 - Medicaid Providers Who Bill on the CMS-1500
(1) All Medicaid providers and their billing
agents who submit claims on behalf of an enrolled Medicaid provider who are
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. The handbook is available from the Medicaid fiscal
agent's Web Portal at http://mymedicaid-florida.com. 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
Contact Center at 1(800)289-7799 and selecting Option 7.
(2) The following forms that are included in
the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, are
incorporated by reference: in Chapter 1, the CMS-1500 Claim Form, Approved
OMB-0938-0999 Form CMS-1500 (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, DF-ES 2902, June 2003, one
page; Consent For Sterilizatión, HHS-687 (11/2006), doublesided;
Consentimiento Para La Esterilizacion, HHS-687-1 (11/2006), doublesided; State
of Florida, Hysterectomy Acknowledgment Form, HAF 07/1999, one page; State of
Florida, Exception to Hysterectomy Acknowledgment Requirement, ETA 07/2008, one
page; State of Florida, Abortion Certification Form, AHCA-Med Serv Form 011,
August 2001, one page. All the forms except for the Healthy Start Prenatal Risk
Screening Instrument are available from the Medicaid fiscal agent by calling
the Provider Contact Center at 1(800)289-7799 and selecting Option 7 or from
its Web Portal at http://mymedicaid-florida.com. Click on Public Information
for Providers, then on Provider Support, and then on Forms. The Healthy Start
Prenatal Risk Screening Instrument is available from the local County Health
Department.
Notes
Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912 FS.
New 10-1-03, Amended 7-2-06, Amended 3-7-07, 4-9-08, 12-3-08.
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