Florida

CMS regulates all laboratory testing (except research) performed on humans in the U.S. through CLIA. To enroll as Medicaid providers and to remain enrolled, providers with laboratories must be certified under CLIA for the tests that they perform. Beginning July 15, 2012, the Florida Medicaid Management Information System (FMMIS) will begin checking for a valid CLIA certificate number for all laboratory claims submitted. Initially, FMMIS will pay the claim even if a CLIA number is not on file with Medicaid.

MedSolutions is pleased to announce its partnership with Florida Medicaid to provide authorization services for Florida Medicaid recipients for dates of service beginning Wednesday, February 1, 2012. This means that claims submitted with a date of service on or after February 1, 2012, will deny if the procedure has not been prior authorized by MedSolutions, Inc., (the company selected to manage this prior authorization program). MedSolutions is now accepting prior authorization requests via fax, phone, or through their Web based system.

Florida Medicaid requires all initial or renewing provider applicants to submit fingerprints for purposes of obtaining a criminal history record check unless they meet one of the exemptions as described in the statute.

New or renewing applicants to Florida Medicaid who were fingerprinted by the Department of Health (DOH) within the previous twelve (12) months may submit proof of that screening in lieu of fingerprints with their new or renewing application to Florida Medicaid.

In order to enhance Medicaid efforts to ensure that the program is providing quality, affordable health care for all Americans, the United States Congress included provisions in the Patient Protection and Affordable Care Act of 2009 that mandates changes in Medicaid rules for enrolling providers and submitting claims. Starting January 1, 2011, Medicaid will require that all providers who must obtain an NPI include their NPI on all claims submitted to Medicaid. This will include all claims from these providers, whether submitted on paper or electronically.