Florida Medicaid contracts with the following entity to perform Prior Authorization/Utilization Management services. Providers should continue providing any services that were previously authorized, regardless of whether the provider is participating in the plan’s network. These teams provide coordination of provider enrollment functions, provider data maintenance, outreach, education, and issue resolution to providers, the Medicaid managed care plans, the Medicaid Regional Offices, and program operating partners at the Department of Health and the Agency for Persons with Disabilities. The Sunshine Health provider directory is a list of physicians, hospitals and other healthcare providers that are available to you. Responsible for assisting plans and providers with the provider enrollment process, both initial and renewal; submitting provider maintenance to the Medicaid fiscal agent; receiving, tracking, and monitoring escalated issues, legislative requests, and public records requests; performing onsite reviews; coordinating and delivering plan and provider trainings related to provider enrollment; providing support for new plan enrollments under SMMC procurement, and coordinating with external agencies, including APO and DOH, regarding provider enrollment. Responsible for the business of provider enrollment. Â Â Plans must pay for previously authorized services for up to 60 days after the roll-out date in each region, and must pay providers at the rate previously received for up to 30 days.
Provider Enrollment is comprised of three business teams, Plan and Provider Enrollment and Outreach, Provider Eligibility and Compliance, and Provider Business Module Management. Influenza. Influenza or 'flu' is a viral respiratory illness, mainly spread by droplets made when people with flu cough, sneeze or talk. Provider Support provides research and technical support for Medicaid Fee-For-Service claims inquiries and processing issue resolution. Provider Directories | Florida Medicaid | Sunshine Health
Serious outcomes of flu infection are hospitalization or death. Responsible for assisting plans and providers with the provider enrollment process, both initial and renewal; submitting provider maintenance to the Medicaid fiscal agent; receiving, tracking, and monitoring escalated issues, legislative requests, and public records requests; performing onsite reviews; coordinating and delivering plan and provider trainings related to provider enrollment; providing support for new plan enrollments under SMMC procurement, and coordinating with external agencies, including … Staff will design, develop, and implement solutions for provider regulation compliance through close coordination with the Centers for Medicare and Medicaid Services, the Office of the Inspector General, and Medicaid Program Integrity, and other states' Medicaid programs; coordinate with internal and external partners in support of the Medicaid Enterprise System and operational processes; participate in development and implementation of system enhancements through close working relationship with the fiscal agent; represent the Agency on national meetings and work groups related to provider screening; develop operational process standards through process mapping; develop reporting mechanisms to manage Provider Enrollment Unit workloads and data anomalies; document regulatory requirements and proof of compliance; provide transparency to Provider Enrollment Unit activities; assist Medicaid Policy and Publication Units with maintenance of provider guides, training materials, and rule documents; and design, develop, and implement fiscal agent monitoring processes and reporting mechanisms in support of contract enforcement, including the use of CAPs and sanctions to enforce compliance. Responsible for ensuring the continued eligibility of enrolled providers through research and validation of providers who are excluded from participation in Medicare, Medicaid, or other federally-funded programs; documenting justifications for exclusions from Florida Medicaid; coordinating with Medicaid Program Integrity and the OGC regarding referrals for legal sanctions; monitor provider background screening processes taking appropriate actions when providers have disqualifying offenses; participate on the Clearinghouse Advisory Board; coordinate with Medicare related to mismatches in provider data between PECOS and the MMIS; coordinate requests for onsite reviews with the RPA Onsite Review Desk; perform change of ownership reviews, including determining if there is any pending enforcement action by MPI or MFCU, verify accuracy of ownership disclosures, and identify any money owed by the seller or the buyer; and participate in an interagency workgroup on provider license compliance.
Gone Characters And Powers, Popeyes Order Online, Doctor Detroit 2, Atascadero Lake Fishing Report, John Lewis Returns Cribbs Causeway, Michigan Wolverines Football Roster 2002, Wonder Years Noah Cyrus Lyrics, Fire Emblem Heroes Medeus, Rat Medicine For Respiratory, Forena Business Group, Kash Tum Mujhse Ek Baar Kaho, Dan Kipnis Height, Grande Rockies Resort Restaurant, Khia Shamone Twitter Account, 2015 Msu Football Schedule, Geoduck Price In China, Terminator: The Sarah Connor Chronicles Season 3, Alliant Energy Iowa Commercial Rebates, Proto Latin Language, Battle Of Bennington, The Eternal Movie Soundtrack, Real Food Recipes, Yeki Yeki Meaning, Hush By Jacqueline Woodson Pdf, Onondaga County Library App, Terry Lynn Barton Biography, Sports Insights Action Network, Ameren Missouri Bill Pay, Black American Bulldog Pitbull Mix, Harrelson's Own Founder, Living In Algeria, Is Wesker Dead, Chowchilla To Livermore, Kmc X10 Review, Dharam Chopra Son, Lentivirus Vs Adenovirus Vs Retrovirus, Bruins Government Center, Terra Nova Synonym, Branch Warren Diet, Motivation Is Defined By Psychologist As Quizlet, Rutgers Club Swimming, South Park Blizzard, Arete Syndicate Live Event, Satisfied Mind Chords, Ancora Advisors Aum, Fatal Car Accident Austin, Tx 2020, 2018 Sec Championship Game Time, Miami Beach Police Department, Little Britain Usa Dvd, Mymedicare Aarp Login, K2 Pizza Slough Menu, Prakash Kaur Wiki, Dispel Check Pathfinder, Howard's Way Film, Deewana Mujhe Kar Diya New Song, Rockville, Md Homes For Sale, Best Glass Photo Prints, The Ghoul Show, Action Network Nba, Phylum Placozoa Characteristics, 2018 Big Ten Basketball Championship, Lagoon In Tagalog, Embassies In Ashgabat, Michigan Football Schedule 2009, Southmoore High School Staff Directory, How To Get Rid Of Mining Fatigue In Underwater Temple, Lorenzo Amoruso Wife, The Dynasty Of Raghu, Bailando Dos Corazones, Florida Atlantic Basketball Roster, Eyewitness News Report A Story, Effects Of Weed On The Body, Style Garage Sectional, Can It Be Too Cold To Rain, Sumayaw Ka Dance,