FAQ Members/Providers

Members | Providers

Members

What is MediPass?

Most Medicaid recipients must enroll in a managed health care plan. MediPass is one of your Medicaid managed health care choices. All the benefits you had before under Medicaid are the same with MediPass.

In MediPass, you will have a doctor or health care center that is your provider. You will go to your provider for check-ups and when you are sick. Your provider will give you or arrange for all of your health care, keep all your medical records up-to-date and in one place, refer you to a specialist when it is necessary, and arrange to admit you to a hospital, when needed.

Will my Medicaid covered services change?

No. You are still eligible to receive the same health care services under MediPass. If your provider does not offer a medically necessary service that you need, your provider will refer you to another Medicaid provider who can give you the care you need.

Does MediPass have a program for people with chronic health conditions?

Yes, MediPass has special programs for people living with chronic conditions who have HIV/AIDS, and Hemophilia. MediPass will contact you if you are eligible for these programs. Call your local Medicaid office for more information.

What if I need to see a specialist or go into the hospital?

Call your MediPass provider. Your MediPass provider can refer you to any Medicaid provider for specialty care or arrange to admit you to a hospital that takes Medicaid.

Will I get a new Medicaid card?

No. You will keep the same gold Medicaid card. You will still need to show your Medicaid card when you get medical care. Your MediPass and Medicaid providers will need your Medicaid card to see if you are enrolled in Medicaid and eligible for their services. You should keep your Medicaid and MediPass cards together. The MediPass card has the name of your MediPass provider, provider address and phone number on it.

What if I need emergency care?

If you have an emergency and you think a delay in getting care might result in death or permanent harm, you should immediately call 911 or go to the nearest hospital emergency room. If you do go to the emergency room, you should call your MediPass provider once the emergency is over. Your doctor may need to see you for follow-up care or refer you to a specialist.

What if I have medical questions or need non-emergency care after office hours?

You can call your MediPass provider 24 hours per day, seven days per week. Your MediPass provider will be able to help you.

Can I change my MediPass provider?

Yes, you can change your MediPass provider at any time. Just call your local Medicaid office for help to change providers.

How do I get Mental Health Services?

You must get your mental health services through a pre-paid mental health plan. Call your local Medicaid office for more information.

Can I change my MediPass provider?

Yes, you can change your MediPass provider at any time. Just call your local Medicaid office and ask to pick another MediPass provider.

Are there services I can get without going to see my MediPass provider first?

For some services, you can make an appointment with your county health department or any Medicaid provider without getting a referral from your MediPass provider. These services include:

*If you live in Hillsborough, Manatee, Polk, Highlands, or Hardee County and you need mental health services you must get them through the Florida Health Partnership at 1-800-808-8033.

If you live in Escambia, Santa Rosa, Walton, or Okaloosa County and you need mental health services you must get them through Access Behavioral Health at 1-866-477-6725.

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Providers

Where do I call when I have a Medicaid question on:

Provider enrollment

Call HP Provider Enrollment at 800-289-7799, Option 4.

Medicaid Application

Call HP Provider Enrollment at 800-289-7799, Option 4.

Medicaid policies (handbooks)

Call HP Provider Enrollment (800-289-7799, Option 7) for the handbook CD or go to the HP website, www.mymedicaid-florida.com , and go to Public information for Providers then Provider Support, and go to Handbooks.

I can't find my Remittance Voucher (RV) for a certain date and I need another copy.

Call HP Provider Enrollment at 800-289-7799 for a replacement copy.

Why are MediPass recipients allowed to change PCP every month?

It is important to allow recipients to have freedom of choice. Recipients have freedom to change providers within their plan on a monthly basis. However, they are encouraged to find a medical home.

Is it allowable for a MediPass doctor to perform a consultation on a recipient assigned to them (or their group)?

No, if the patient is assigned to the PCP he cannot bill for a consultation performed by himself even if he has more than one specialty.

If a MediPass recipient goes into a nursing facility, who does the nursing facility contact regarding MediPass disenrollment?

Contact the MediPass Coordinator in the Medicaid office to request to a disenrollment.

Do you have a specialist's list online I can use when referring my patients?

Specialty directories are maintained by the local Medicaid offices. For an updated list, please contact your local Medicaid office.

How do I become a MediPass provider?

Contact your Medicaid office and request an enrollment package, then submit the application to your local Medicaid office for processing.

Coinsurance and/or deductibles

Can I bill my MediPass beneficiaries any additional fees?

No. A provider who bills Medicaid for reimbursement of a Medicaid-covered service must accept payment from Medicaid as payment in full. This does not include Medicaid copayments and Medicaid coinsurance (Florida Medicaid Provider General Handbook, Chapter 1, page 6 – Payment services). For information on billing for non Medicaid covered services please see Florida Medicaid Provider General Handbook, Chapter 1, page 7.

Authorizations

Are MediPass providers supposed to see their assigned recipients before giving an authorization to another doctor, especially for services they can do?

It would be ideal for the patient to get established with the PCP before any authorization is given; however, patients can have on-going treatments or appointments with specialty doctors already in process before a new assignment occurs. The MediPass PCP should use good medical judgment in determining the need to authorize services in these cases so as not to interfere with the care of the patient. If the service is a general medical visit that could be provided at the MediPass PCP office, the MediPass PCP can refuse authorization and suggest the patient be seen in their office.

Can the MediPass authorization be used for out of state treatment/visits?

No. Prior authorization for out-of-state services requires unique authorization granted by the Medicaid Services/Medicaid Prior Authorization Unit. For additional information on out-of-state services refer to the Medicaid Provider General Handbook.

Claims

My claim keeps denying for Third Party Liability (TPL), but the recipient only has Medicaid. What can I do?

Call Health Management Systems (FL TPL Recovery Unit) at 877-357-3268. They have contracted with Florida Medicaid to handle Third Party Liability. They can give you instructions on how to have the TPL removed from the recipient's file

How can I find out the status on my claim or my check amount?

Call HP Provider Inquiry at 800-289-7799. Check amounts are also available through the Automated Voice Response System (AVRS) at 800-239-7560.

I have paper claims that I need to send to the fiscal agent for payment. What is the address?

There are different post office boxes for claims depending on the claim type. The address for each type is in the Provider General Handbook. Go to the HP website, www.mymedicaid-florida.com, and go to Public information for Providers then Provider Support, and go to Handbooks. You may also call HP Provider Inquiry number at 800-289-7799.