Servicios para miembros: 1-844-243-5187 (para sordomudos, use el 711) Disponible de 8 a. m. a 7 p. m., de lunes a viernes | Ayuda con el idioma

Miami Children's Health Plan is led by doctors that live and work in South Florida.

 

Provider Alert


IMPORTANT INFORMATION REGARDING HURRICANE DORIAN

On August 28 2019, Governor Ron DeSantis declared a state of emergency in preparation for Hurricane Dorian.  As such, Miami Children’s Health Plan (MCHP) would like to offer important information to our providers.

Provider Assistance
Providers needing assistance should call MCHP’s toll-free number at (844) 243-5187 to reach a Customer Service representative. 

For Behavioral Health related issues, please contact Beacon Health Options at (888) 710-2313.

For non-emergency transportation needs, please contact One Call Transportation at (877) 340-9491.

Claims Payment and Authorizations
Providers are reminded to continue to provide critical and medically necessary services to all MCHP members. In those instances where a provider and/or enrollee could not comply with pre-authorization policy requirements because of storm-related impact, MCHP will not deny medically necessary services solely on the basis of not obtaining a prior authorization for participating or non-participating providers.

Submitting Claims
In the event the provider office loses immediate or extended internet connectivity following the storm and is not able to submit claims electronically, provider can submit paper claims directly to MCHP to the address below.

Miami Children’s Health Plan
PO BOX 211241
Eagan, MN 55121
 

Providers without a Florida Medicaid identification number who rendered services before, during, or after the storm

All medically necessary services provided under a state of emergency are covered regardless of provider network participation status and/or service.

MCHP requires that non-participating providers follow appropriate credentialing procedures.  If a provider is not registered with Florida Medicaid, the provider must cooperate with MCHP to complete the Agency’s provisional (temporary) enrollment application and obtain a Medicaid Identification Number. The process for provisional provider enrollment is located at http://www.mymedicaid-florida.com.

 

Our provider partners are what make our plan different.  We look forward to working with you to support the communities we serve together.

 

Benefits to Physicians & Providers

 
Clinical Support
  • High- quality patient data and practical, actionable physician reports and analytics
  • Local care managers and clinical performance improvement expert support
Service Focused
  • Timely and accurate claims payment
  • Clear and efficient credentialing
  • Local physician creation of policies and prior authorization lists to reduce abrasion
Local Decision Making
  • Local physician engagement in clinical decisions customized to community and patient needs
Flexible Contracting Models
  • Innovative reimbursement and incentive redesign developed with local physician input
  • Insightful and trustworthy information to manage performance


Continuity of Care (COC)

Miami Children’s Health Plan (MCHP)is required to ensure continuity of care (COC) during the transition period for Medicaid recipients enrolled in the SMMC program.  COC requirements ensure that when enrollees transition from one health plan to another, one service provider to another, or one service delivery system to another (i.e., fee-for-service to managed care), their services continue seamlessly throughout their transition. 

MCHP will comply with the below COC provisions:

  • Health care providers should not cancel appointments with current patients. MCHP will honor any ongoing treatment that was authorized prior to the recipient’s enrollment into the plan for up to 60 days after the roll-out date in each region. There must be no disruption of care for enrollees. Care may continue after the transition period with prior authorization. 
  • Providers will be paid. Providers should continue providing any services that were previously authorized, regardless of whether the provider is participating in the plan’s network. MCHP will 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. 
  • Providers will be paid promptly.  During the continuity of care period, MCHP will follow all timely claims payment contractual requirements.  The Agency will monitor complaints to ensure that any issues with delays in payment are resolved. 
  • Prescriptions will be honored. MCHP will allow recipients to continue to receive their prescriptions through their current provider, for up to 60 days after the roll-out date in each region, until their prescriptions can be transferred to a provider in the plan’s network.
 
Region Implementation Date Transition Period End Date

9

12/01/2018

01/31/2019

11

12/01/2018

01/31/2019