AHCA Logo

Medicaid Fiscal Agent Operations

Gay L. Munyon
Bureau Chief

2562 Executive Center Circle E
Montgomery Bldg., Suite 100
Mail Stop #22
Tallahassee, Florida 32301

Phone: (850) 412-3400
Fax: (850) 410-1430

The Bureau of Fiscal Agent Operations has oversight responsibilities for the Fiscal Agent provider enrollment, claims processing and payment, management of the the Florida Medicaid Management Information System (FMMIS) and the Decision Support System (DSS). 

Florida Health Care Connections Procurement Strategy

During 2015 and 2016, the Agency performed planning and research, held conference calls with other states, sought input from vendors, and participated in discussions with CMS regarding the transition of the Florida Medicaid Management Information System (FMMIS) and Decision Support System (DSS).  As a result, the Agency determined that additional strategic and technical expertise was needed to facilitate the transition of the Medicaid systems.

The Agency executed a contract for the services of a Strategic Enterprise Advisory Services (SEAS).  The SEAS vendor provides the expertise needed to develop data and technology standards, propose solutions for the FX Program in accordance with the CMS Standards and Conditions, including MITA 3.0, and provides strategic, programmatic, and technical advisory services for the Agency. 

The Agency also executed a contract for FX IV&V Services.  The IV&V vendor provides independent evaluation and review processes that evaluate the adherence to the standards, correctness, and quality of the FX projects’ solutions and ensures that FX projects are developed and managed in accordance with Agency and Federal requirements. The IV&V vendor will also participate in the CMS-required reviews for the Medicaid Enterprise Certification of FX projects.

Provider Enrollment

The bureau section provides coordination of Fiscal Agent provider enrollment functions, provider data maintenance, outreach, education, and issue resolution to providers, the Medicaid managed care plans, the Medicaid Regional Offices, and program operating partners at the Department of Health and the Agency for Persons with Disabilities.

Recipient File Management

The bureau section maintains integrity of recipient eligibility data in the FMMIS and provides oversight of Medicaid Fiscal Agent recipient file management functions.

Special Projects/Project Management

This bureau section ensures compliance of the Florida Medicaid Management Information System (FMMIS) with federal and state regulations; develop federal Advance Planning Documents (APD) to receive approval for Medicaid system projects and enhanced federal funding, and develop state Legislative Budget Requests (LBR) for fiscal agent projects.

Decision Support Systems

This bureau section monitors the Decision Support System (DSS) portion of the Fiscal Agent contract to ensure system availability, access and accuracy for authorized State users.  The DSS staff also assists users with building ad hoc queries, customized reports and large data extracts.

Compliance Reporting and Claims/Encounter Support

This bureau section is responsible for contract compliance reporting of all phases of the Medicaid Fiscal Agent’s operations.

Systems Maintenance

This bureau section is responsible for arranging, coordinating and reviewing System Maintenance Customer Service Requests (CSR); file maintenance, audits, claims reprocessing, issue identification and production issues resolution.

Systems Projects

This bureau section is responsible for coordinating, developing, processing and approving CSRs submitted to the Fiscal Agent. Staff is also responsible for planning, coordinating, and overseeing special projects. 

Reference Information

Resources Information

HIPAA EDI

More information for the Health Insurance Portability and Accountability Act (HIPAA) can be found at the HIPAA Compliance Office web page.

Electronic Health Records (EHR) Florida Medicaid Incentive Program