A Division of the Agency for Health Care Administration

Florida Medicaid Health Care Alert January 18, 2018

Provider Type(s): All
Provider Enrollment Screening Enhancements Medicare Provider Records

The Affordable Care Act requires that the Agency for Health Care Administration (Agency) conduct pre-and post-enrollment screenings to ensure that providers initially meet and continue to meet the enrollment criteria for their provider type.

As an enhancement to the provider screening process, the Agency will soon implement automated checks to compare Florida Medicaid provider application data against Medicare's Provider Enrollment Chain of Ownership System (PECOS) database for those providers who are enrolled in both Medicare and Florida Medicaid.

All providers currently enrolled in Medicare are encouraged to review the information on their Medicare PECOS provider file, and to promptly complete any necessary updates, to ensure that Florida Medicaid receives current and accurate information. Items that will be checked include the provider name, tax ID, National Provider ID, ownership, date of birth, and the service address.

The Agency will implement the automated checks as part of the Florida Medicaid provider enrollment screening process in early 2018. Look for future alerts related to this and other enhancements.

Florida Medicaid Health Care Alert September 01, 2017

Provider Type(s): All
Notification of Changes to the National Provider Identifier (NPI) Registration Process

The Agency for Health Care Administration (Agency) is announcing that an update to the NPI registration process was implemented on August 25, 2017.

Changes include:

  • A new validation process to prevent adding the same NPI information to multiple provider records. Should NPI information submitted as part of an application or an update to an existing provider record already exist on another provider record, the new NPI information will be rejected. The provider will receive an error message directing them to submit a modified NPI information request.
  • An online, searchable Taxonomy Guide provided to view a list of taxonomies appropriate for each provider type and specialty.
  • An interactive menu for selection of taxonomies on the Web-based Provider Enrollment Wizard. The menu will present a dropdown list of the taxonomies that are appropriate for the provider type and specialty entered on the application. This new feature will be available on both the Provider Type and Specialty panel and the NPI panel. 
  • A new “Date Used for Claims” field will be associated with the NPI on a provider’s record. This field indicates whether the date of service on a claim or the date the claim is submitted will be used by Medicaid in matching the claim NPI to a Medicaid provider record.

                      * “Date of Service” – The claim’s NPI must be on the provider’s record for the date of service, regardless of date of submission.

                          * “Date of Submission” – The claim’s NPI must be on the provider’s record for the date of submission, regardless of date of service.

Providers can view the “Date Used for Claims” field on their secure Web Portal page. 

The Agency has posted three NPI-related documents on the Enrollment Forms page of the public Web Portal as part of this process change.

  • NPI Registration Form: Requires a valid taxonomy code and ZIP code when updating an NPI crosswalk for Florida Medicaid.
  • NPI Registration Guide:  Contains useful information to assist providers when filling out the NPI Registration Form.
  • Florida Medicaid Taxonomy Guide: Provides a searchable list of the taxonomies by provider type and specialty. This is a valuable resource when completing an NPI Registration Form or preparing to submit a new Medicaid provider enrollment application.

NOTE: The Agency will continue to accept the old NPI Registration Form through October 31, 2017. After October 31, 2017, only the revised NPI Registration Form (August 2017) will be accepted.

Providers may contact the Provider Enrollment Call Center at 1-800-289-7799, option 4, or their local Field Services Representative for any assistance with the enrollment process.