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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 with any questions.

We will continue to update our policies based on evolving events and AHCA guidance.   

Provider Enrollment Flexibilities

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, Miami Children's 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 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.

Prior Authorizations and Limits

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. 

Update Effective June 19, 2020: Consistent with Phase 2 of Governor Ron DeSantis’ Plan for Florida's Recovery, Miami Children’s Health Plan will reinstate prior authorization requirements for the following services that were previously waived in response to COVID-19:
  • Hospital services (including long-term care hospitals)
  • Nursing facility services
  • Physician services
  • Advanced practice registered nursing services
  • Physician assistant services
  • Home health services
  • Ambulance transportation; and
  • Durable medical equipment and supplies.
This change is effective for dates of service on or after June 19, 2020, when prior authorization is required for the service. For additional information, please see AHCA related alert here.

This change does not include Behavioral health services covered under the Medicaid program. All prior authorization requirements and service limits for all behavioral health services, community behavioral health services, inpatient behavioral health services, and targeted case management services are waived until further notice.  The AHCA related guidance on Behavioral Health issued on April 21, 2020 and May 5, 2020 is still in place. View related AHCA alerts. View related AHCA alerts 2020-24 and​ 2020-31​.

On July 9, the Agency issued alert 2020-39, and updated it on July 14 with alert 2020-41 to facilitate prompt hospital discharges and to ensure adequate inpatient hospital capacity in response to COVID-19. With these changes, Florida Medicaid is waiving service authorization requirements prior to admission for hospital transfers, including:

  • inter-facility transfers:
  • transfers to a long-term care hospital; and
  • transfers to a nursing facility.

This change applies to the fee-for-service and managed care delivery system. The Agency will continue this flexibility until further notice.
Statewide Medicaid Managed Care

  • The waiver of prior authorization applies whether the receiving facility is a participating provider or non-participating provider in the health plan’s network.
  • Health plans may require the receiving facility to notify the plan of the admission within forty-eight (48) hours of the admission. At that point, the plan may request additional clinical information to begin concurrent/continued stay reviews to facilitate care coordination and discharge planning.
  • Fee-for-Service Delivery System
  • For inter-facility hospital transfers (hospital to hospital), the receiving hospital facility will need to request a simple, administrative prior authorization through eQHealth Solutions to ensure streamlined reimbursement. Clinical reviews will not take place at this time.


Preadmission Screening and Resident Review (PASRR) processes may be postponed until further notice.  Retro screenings and reviews must document the reason for the delay.

Non-urgent and non-emergent services

Providers must delay services that are considered non-urgent/non-emergent and will not place the enrollee's health at risk. The executive order on non-urgent and non-emergent services can be found at this link. In order to reduce the administrative burden for providers that already obtained approval for procedures postponed as a result of this executive order, Miami Children's Health Plan will extend the approval period for affected authorizations for at least six months.

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. The plan will eliminate restrictions on the use of mail order delivery of maintenance medications.

Members may request a 90-day supply of medications when that quantity is available at the pharmacy. They may also request a 90-day supply of their medications be delivered through mail order.

For additional information, please contact member services.

Fair Hearings

Members may have more time to request a fair hearing and appeals.

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.

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.

Telemedicine Modifiers:

Telemedicine Guidance for Behavioral Analysis Services

Telemedicine Guidance for Therapy Services and Early Intervention Services

Well-Child Visits

The Agency is allowing limited use of telemedicine to accomplish well child visits where safe to do so. 
This information is from AHCA Alert sent out on 5/29/2020- Well-Child Visits Provided Via Telemedicine During the COVID-19 State of Emergency

Telemedicine Well-Child Visits for Children Older than 24 Months Through 20 Years

The Agency understands that well-child visits are just as important as sick visits to ensure children receive quality care at their medical home. Florida Medicaid reimburses for well-child visits in accordance with the recommended schedule developed by the American Academy of Pediatrics. To promote health and wellness through preventive care during the COVID-19 state of emergency, the Agency is expanding telemedicine to include well-child visits.

Providers may render a well-child visit using telemedicine (live/two-way communication that includes audio and video) during the state of emergency for children older than 24 months through 20 years for the following procedure codes:
  • 99382-99385
  • 99392-99395
Providers must append the GT modifier for live, two-way communication. The Agency and the Medicaid health plans will reimburse the same rate as if the service was delivered face-to-face.

Though it may be necessary to conduct a well-child via telemedicine, it is the Agency’s expectation that providers actively work to schedule a follow-up visit to administer immunizations and other physical components of the exam that could not be delivered using telemedicine. Immunizations are critical to reducing and eliminating preventable diseases. Immunizations should be scheduled as soon as possible to ensure children can remain on schedule for these important services. The follow-up visit will eligible for Medicaid reimbursement. Additional guidance will be forthcoming regarding the follow-up visit to render the remaining components of the well-child visit (i.e., a comprehensive physical exam and/or immunizations) .

Well-Child Visits for Children 24 Months and Younger

In accordance with the American Academy of Pediatrics guidance, providers should prioritize in-person newborn care, newborn well-visits, and immunization of infants and young children through 24 months of age. Therefore, Florida Medicaid will not reimburse for well-child visits performed via telemedicine for children ages 24 months and younger.

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Miami Children's Health Plan is a Managed Care Plan with a Florida Medicaid Contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the Managed Care Plan. Limitations, copayments, and/or restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change.

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