Important Information

System Messages

Now Available! Updated NPI to Medicaid ID Search Engine Quick Reference Guide

The Agency for Health Care Administration (Agency), along with their fiscal agent, Gainwell Technologies, would like to inform health plans that the Provider Master List (PML) and Pending Provider List (PPL) layouts have been updated and are now available.

The Agency for Health Care Administration (Agency), along with their fiscal agent, Gainwell Technologies, would like to inform providers that the NPI to Medicaid ID Search Engine Quick Reference Guide (QRG) has been updated and is now available. The QRG includes information regarding the following enhancements made to the NPI to Medicaid ID Search Engine tool:

  • Added a link to the Taxonomy Master List (TML);
  • Included an expandable menu (+/-) that will display all valid taxonomies for specialties associated with a provider’s Medicaid ID;
  • Displays NPI Details (effective date, end date, and status); and
  • Displays Contract Details (effective date, end date, and status)

On February 15, 2024, the NPI to Medicaid ID Search Engine will no longer be available on the public Web Portal and will only be available to those logged into their secure Web Portal. The enhanced tool is available by clicking the NPI to Medicaid ID Search Engine link under the Quick Links box within the secure Web Portal.

Note: The NPI to Medicaid ID Search Engine will be accessible on the public Web Portal only for those who are applying and entering an NPI for full, limited, or ROPA enrollment through the Online Enrollment Wizard

The updated NPI to Medicaid ID Search Engine QRG is located on the Florida Medicaid Public Web Portal at mymedicaid-florida.com, then navigating to Agency Initiatives and selecting NPI Initiative

For information on how to perform a password reset for a secure Web Portal user account that is locked, refer to the Secure Web Portal Account Maintenance Quick Reference Guide (QRG).

Thank you

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Scheduled Maintenance

Please review the Scheduled Maintenance document for a comprehensive list of 2024 scheduled maintenance dates.

Holiday Office Closure

Please review the Holiday Office Closure document for a comprehensive list of 2024 scheduled holidays.

Now Available! Updated Provider Master List and Pending Provider List

The Agency for Health Care Administration (Agency), along with their fiscal agent, Gainwell Technologies, would like to inform health plans that the Provider Master List (PML) and Pending Provider List (PPL) layouts have been updated and are now available.

The PML and PPL were updated to assist the health plans accurately identify provider data for claims processing. The PML and PPL had the following NPI Crosswalk related columns removed:

  • NPI Crosswalk - Taxonomy
  • NPI Crosswalk - Zip Code
  • NPI Crosswalk Status

Health plans can access the updated PML and PPL on the Florida Medicaid Public Web Portal by navigating to Managed Care>Registration. The updated versions of the PML and PPL are posted under Current Versions of the Provider Information Reports section of the Registration page. A copy of the old version of the PML and PPL can be found on the Registration page under Previous Versions Last Updated 10/26/2023.

The PML and PPL tip sheets have been updated and contain guidance on the updated PML and PPL layouts. To access the tip sheets on the public Web Portal, navigate to the Agency Initiatives tab, and select NPI Initiative.

Thank you.

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Now Available! New Taxonomy Master List (TML)

The Agency for Health Care Administration (Agency), along with their fiscal agent, Gainwell Technologies, is introducing a new Taxonomy Master List (TML) as one (1) of the enhancements implemented as part of the new NPI initiative. The new TML has a similar layout to the Provider Master List (PML) and is available for download in both CSV spreadsheet and TXT pipe delimited formats on the NPI Initiative page of the public Web Portal. The TML will be replacing the current Taxonomy Guide and also includes:

  • The Provider Type number associated with the Provider Type description; and
  • The Specialty Type number associated with the Specialty Type description.

Note: The new TML will not change the mapping logic related to taxonomy.

For more information, a new TML Tip Sheet is available on the Florida Medicaid Public Web Portal at mymedicaid-florida.com, navigate to the Agency Initiatives tab, and select NPI Initiative.

Thank you.

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Now Available! New TML Tip Sheet and Updated PML and PPL Tip Sheets

The Agency for Health Care Administration (Agency), along with their fiscal agent, Gainwell Technologies, is introducing enhancements implemented as part of the new NPI initiative.

A new Taxonomy Master List (TML) Tip Sheet is now available.

The tip sheet consists of the following information:

  • Contents of the TML;
  • TML Publication Frequency;
  • TML File Layout; and
  • Information on additional resources and more.

An updated Provider Master List (PML) Tip Sheet is now available.

The tip sheet consists of the following information:

  • Changes to the PML;
  • Contents of the PML;
  • PML Publication Frequency;
  • PML File Layout; and
  • Information on additional resources and more.

An updated Pending Provider List (PPL) Tip Sheet is now available.

The tip sheet consists of the following information:

  • Changes to the PPL;
  • Contents of the PPL;
  • PPL Publication Frequency;
  • PPL File Layout; and
  • Information on additional resources and more.

Note: The updated PML and PPL test examples are now available. The release of the updated PML and PPL changes will occur on October 26, 2023. After the release, a copy of the former version of the PML and PPL will remain archived on the Registration page of the Managed Care section of the Florida Medicaid Public Web Portal for reference.

The release of the update TML changes will occur on September 28, 2023. The release will replace the current version of the TML on the Florida Medicaid Public Web Portal.

To access a copy of the new TML Tip Sheet and the updated PML and PPL Tip Sheets, please visit the Florida Medicaid Public Web Portal at mymedicaid-florida.com and navigate to Agency Initiatives, and select NPI Initiative.

Thank you.

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Exceptional Claims

Reminder: Submitting claims correctly will most likely result in speedier processing.

  • An ICN is received upon submittal of an exceptional claim. Please use this ICN to track the status of your exceptional claim and do not submit the same exceptional claim again as this may affect the timeliness of the process.
  • Claims that are within 12 months of the date of service, and require attachments such as Third Party Liability (TPL), Explanation of Benefits (EOB) and/or required consent forms (Sterilization, Hysterectomy, Therapeutic Abortion), should be submitted as regular claims as exceptional claims processing is not normally needed.
  • Medicare Crossover claims should be submitted as regular claims as exceptional claims processing is not normally needed.
Now Available! NPI Initiative Page

The new NPI Initiative page is now available! This new page includes information about upcoming updates to the Provider Master List (PML), Pending Provider List (PPL), NPI to Medicaid ID Search Engine, and much more. Listed below is the information included on the new NPI Initiative page:

  • Enhancements to the NPI Mapping Logic
  • Updates to NPI-related documents (Quick Reference Guides, Frequently Asked Questions, Tip Sheets)
  • Updates to the PML and PPL - Coming Soon!
  • Renaming the Taxonomy Guide to Taxonomy Master List (TML)
  • A new TML layout - Coming Soon!
  • A new TML Tip Sheet - Coming Soon!

To view the new NPI Initiative page, please visit the Florida Medicaid Public Web Portal at mymedicaid-florida.com and navigate to the Agency Initiatives tab, and select NPI Initiative.

Thank you.

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Update to Encryption Mechanism on Outbound Files for FLMMIS

Beginning June 22, 2023, the Agency for Health Care Administration (Agency), along with its fiscal agent, Gainwell Technologies (Gainwell), will update the encryption service on the Secure File Transfer Protocol (SFTP) server. The file extension will be GPG (GnuPG) instead of PGP (Pretty Good Privacy) for the public key.

This applies only to submitters who submit X12 transactions through SFTP.

To help verify that systems are not impacted by this change, an unencrypted and encrypted version of a “readme” file will be placed into the outbound folder of a provider's account on the SFTP server.

Most encryption/decryption software supports both PGP and GPG encryption. Providers can compare these files after decrypting the encrypted version.

GPG encryption software and support are available at gnupg.org/download/index.html.

For additional questions, concerns, or to participate in testing, please contact the EDI Help Desk at FLEDITEAM@Gainwelltechnologies.com or call 1-866-586-0961.

If you would like to participate in encryption testing planned for May 1-22, 2023, please contact the EDI Help Desk at the email or phone number above.

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Important Reminder for D-SNPs Regarding Encounter Submission

Effective April 1, 2023, Dual Special Needs Plans (D-SNP) are required to submit encounter data to Florida Medicaid for Medicaid funded services. The Agency for Health Care Administration (Agency), along with its fiscal agent, Gainwell Technologies (Gainwell), offer a variety of helpful resources to its D-SNP community to help with their onboarding process and encounter submissions.

D-SNPs can view a checklist of necessary steps to follow when enrolling with Florida Medicaid by visiting www.mymedicaid-florida.com, navigating to Agency Initiatives > SMMC, and selecting DSNP. Each step has a list of references to the relevant section in the Florida Health Plan Guide, and some steps contain links to relevant forms on the portal as well.

All D-SNPs should review the onboarding timeline available on the DSNP section of the public Web Portal to ensure they are enrolled and can successfully submit encounters by the April 1, 2023, deadline.

Note: D-SNPs that do not have previous Florida Medicaid encounter transaction exchange experience are encouraged to test their encounter transaction exchange capability with Florida Medicaid. D-SNPs that are not required to test or have already completed testing may start submitting encounters ahead of the April 1, 2023, deadline.

Thank you

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Urgent Provider Issues

Please review the Known Issues and Informational Items List for details listed related to the MMIS. (Updated 02/15/2023)

Current Topics

Web Portal Administrator Change Request Reminders

There are two (2) options available to Providers/Administrators seeking to reset their password or update the Administrator for their secure Web Portal account.

Option 1: Self-Service Reset Password Tool

Providers/Administrators who remember their account username, email address, and have set up a security question may use the self-service Reset Password tool to reset their password and update their account information. The Reset Password tool is located on the secure Web Portal at http://home.flmmis.com.

Option 2: Letter of Request

Providers/Administrators who do not have the information needed to use the Reset Password tool, and are seeking to update the Administrator for the secure Web Portal account, must email a Letter of Request on company letterhead to flwebportal_password@gainwelltechnologies.com

Note: This mailbox will only assist Web Portal account administrators with initial passwords needed to create a new Web Portal account (example, you did not receive your PIN letter) and updates to existing Provider/Administrator Web Portal accounts.

The letter must include the following:

  • Wet signature by an authorized signer (member in Owners panel on the Provider’s file);
  • Provider ID;
  • Provider Name as it appears on the Provider’s file;
  • Tax ID;
  • Pay To or Mail To address as it appears on the Provider’s file (individuals actively linked to a group, may provide the group’s Pay To or Mail To address);
  • Name of new Secure Web Portal Administrator;
  • Email address of the new Secure Web Portal Administrator;
  • Must contain the following statement:
    • I understand that the Administrator account is granted SuperUser access (with ALL access to the secure Web Portal account), and it is my responsibility to actively manage and maintain my Florida Medicaid Secure Web Portal account; and
  • Indicate if request is for a PIN or if the request is to update the email address for the secure Web Portal account.

Providers will receive an autoreply acknowledging that their email was received. Providers should allow several business days for processing. After the letter of request has been processed, the provider will receive an email advising if the letter of request was accepted or rejected.

For more information related to Web Portal PINs, resetting passwords, and Administrator change requests, please visit the Contact Us page on the public Web Portal.

Thank you.