Fla. Admin. Code Ann. R. 59G-5.020 - Provider Requirements
(1) All Medicaid
providers enrolled in the Medicaid program and billing agents who submit claims
to Medicaid on behalf of an enrolled Medicaid provider must comply with the
provisions of the Florida Medicaid Provider General Handbook, July 2012, which
is incorporated by reference and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-02671
and from the fiscal agent's Web site at www.mymedcaid-florida.com. Select
Public Information for Providers, then Provider Support, and then Provider
Handbooks. A paper copy of the handbook may be obtained by calling the Provider
Services Contact Center at 1(800) 289-7799 and selecting Option 7.
(2) The following forms that are included in
the Florida Medicaid Provider General Handbook are incorporated by reference.
In Chapter 3, Temporary Emergency Medicaid Identification Card, July 2008;
CF-ES 2681, Notice and Proof of Presumptive Eligibility for Medicaid for
Pregnant Women, Feb 2003; CF-ES Form 2014, Authorization for Medicaid/Medikids
Eligibility, Feb 2003; AHCA Form 5240-006, Unborn Activation Form, January
2007; CF-ES 2039, Medical Assistance Referral, Sep 2002. In Chapter 4, AHCA-Med
Serv 038, Crossover with TPL Claim and/or Adjustment Form, July 2008; AHCA Form
5000-3527, Medicare Part C-Medicaid CMS-1500 Crossover Invoice, June 2012; AHCA
Form 5000-3528, Medicare Part C-Medicaid UB-04 Crossover Invoice, June 2012.
Appendix D, AHCA Med Serv Form 2000-0016, Medicaid Out-of-State
Prior-Authorization Request Form, January 2012. The CF-ES forms are available
from the Department of Children and Family Services. The other forms are
available from the Medicaid fiscal agent's Web site at
www.mymedicaid-florida.com.
Select Public Information for Providers, then Provider Support, and then Forms.
Paper copies of the forms may be obtained by calling the Provider Services
Contact Center at 1(800) 289-7799 and selecting Option 7.
Notes
Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.
New 9-22-93, Formerly 10P-5.020, Amended 7-8-97, 1-9-00, 4-24-01, 8-6-01, 10-8-03, 1-19-05, 5-24-07, 2-25-09, 6-13-13.
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