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Recipient File Management

The Recipient File Management Unit (RFMU) updates recipient data in the Florida Medicaid Management Information System (FMMIS).  RFMU performs required file maintenance on a daily basis.  Each unit works cooperatively since all recipient data is related and is co-mingled in FMMIS.  Recipients can be eligible for Medicare and SSI, for example.  Units “share” recipients but perform different file updates and monitor processes related to their functional unit. The section is comprised of three smaller functionally defined units:

  • Recipient
    • The Medicaid recipient file in FMMIS is updated with data files from the Florida Department of Children and Families (DCF) and the Social Security Administration (SSA). The Recipient Unit maintains integrity of recipient eligibility data in FMMIS and provides oversight of Medicaid fiscal agent recipient file management activities and fiscal agent performance.
  • Buy-In
    • Buy-In is the process by which Medicaid pays the Part A and/or Part B premium for Medicare recipients.  The RFMU Buy-In Unit maintains integrity of Buy-In data in FMMIS and provides oversight of Medicaid fiscal agent Buy-in activities and fiscal agent performance.
  • MediKids
    • MediKids is the KidCare health insurance program for children ages 1 through 4. MediKids eligibility and managed care enrollment information is maintained in FMMIS. The RFMU MediKids Unit maintains integrity of MediKids eligibility information in FMMIS with data coming from the KidCare third party administrator and the Agency’s managed care enrollment broker.