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Important Links

COVID-19 General Provider Information: Click Here
 
COVID-19 Provisional Provider Enrollment:
Florida Medicaid Web Portal

Alerts from AHCA:

AHCA Alerts

FLMMS Portal
 

COVID-19 Info for Members:

COVID-19 Information for Members

CDC Information on COVID-19

Florida Department of Health Information on COVID-19

 

COVID-19 Provider Payment Provisions


Centers for Medicare and Medicaid Services issued a set of blanket waivers that states may utilize in response to COVID-19. The Agency for Health Care Administration has received authority for many of these waivers related to health care facilities and licensure requirements. The Agency is actively working to receive the federal authority needed for many of the items listed in this alert related to the Medicaid program.  The Agency will be issuing subsequent guidance related to additional flexibilities or service enhancements that will be enacted to ensure there is no disruption in care for Medicaid recipients in the event of workforce shortages or limitations in recipients seeking care in provider.
 
At Miami Children’s Health Plan we are updating policy and procedures to meet the State guidance and to support our providers.  Our website and resources are routinely updated with information available for your review.  The following information will help guide you through revised credentialing, administrative, claims and support services policies.  We are available to assist you regarding these changes by calling us at  1-844-243-5188 available Monday – Friday  7a – 7p CST / 8a - 8p EST.   You may also call your provider relations specialist directly or email ProviderServices@MiamiChildrensHealthPlan.com with any questions.
 

Submission instructions for providers

Includes provider enrollment requirements and waiver of non-applicable provider credentialing requirements

Provider enrollment and waiver of non-applicable provider credentialing requirements:   To ensure adequacy of providers for treatment of members diagnosed with COVID-19 and under the Agency for Health Care Administration’s directive, Lighthouse Health plan will cover medically necessary services provided to recipients diagnosed with COVID-19, regardless of whether the provider is located in-state or out-of-state. To be reimbursed for services rendered to eligible Florida Medicaid recipients, providers not already enrolled in Florida Medicaid (out-of-state or in-state) must complete a provisional (temporary) enrollment application. The process for provisional provider enrollment will be located at http://www.mymedicaid-florida.com by Thursday, March 19, 2020. In the event of workforce shortages in the State, practitioners that are not already enrolled in Florida can seek enrollment following the instructions above.
 

Minimum documentation requirements for managed care plan decision making

As your health plan partner and under the Agency for Health Care Administration’s directive, Miami Children’s Health Plan will not deny medically necessary services for lack of initial or ongoing prior authorization from skilled nursing facilities, long term acute care hospitals, hospital services, physician services, advanced practice registered nursing services, physician assistant services, home health services, and durable medical equipment and supplies.   For members diagnosed with COVID-19, Miami Children’s Health Plan will not deny medically necessary services to evaluate and treat members diagnosed with COVID-19 for lack of prior authorization.  Miami Children’s Health Plan will waive limits on medically necessary services for these members or members that require services to keep them safely at home.   Medical records may be requested for medical necessity review.  We will continue to update our policies based on evolving events and AHCA guidance.   
 

Claim Submission Requirements

Claim submission requirements remain largely the same with added diagnosis and laboratory testing codes available for COVID-19 related care as well as modifiers for telemedicine.  Please check this website for updates on additional information as the situation develops.
 

Cost Sharing

Miami Children’s Health Plan waives all co-payments, including co-payments for COVID-19 related services.
 

Early Prescription Refills 

Miami Children’s Health Plan has lifted all limits on early prescription refills during the state of emergency for maintenance medications, except for controlled substances. For additional information, please contact member services.
 

COVID-19 Diagnosis Codes:

When submitting COVID-19 related claims, follow the appropriate CDC guidance on diagnosis coding for the date of service. The CDC has provided interim coding guidance on which ICD-10 diagnosis codes to report until a new code becomes effective April 1, 2020.

 Interim code guidelines:

Lab Testing:

Lab providers should use the newly created HCPCS codes when billing for COVID-19 testing. CMS created the following HCPCS codes for testing performed on or after Feb. 4, 2020:
HCPCS U0001: This code is used for the laboratory test developed by the CDC.
HCPCS U0002: This code is used for the laboratory test developed by entities other than the CDC.
 

Telemedicine Modifiers:

Telemedicine Guidance for Behavioral Analysis Services

Telemedicine Guidance for Therapy Services and Early Intervention Services