Provider Services

Provider Enrollment

Provider Enrollment is responsible for enrolling qualified providers to receive Medicaid reimbursement for services rendered to Medicaid Fee-For-Service recipients.

Provider Training

Ownership Changes

Claims Support

Provider Support provides research and technical support for Medicaid Fee-For-Service claims inquiries and processing issue resolution. For assistance contact 1-877-254-1055.

Fee-for-service Exceptional Claims

  • Exceptions to the 12-month claim submission time limit may be allowed, if the claim meets certain conditions.
  • Providers must submit exceptional claims, along with the required Exceptional Claim Form, electronically via the Florida Medicaid Secure Web Portal under the Claims panel. Providers are encouraged to review the Electronic Exceptional Claim Submission Quick Reference Guide, found on the Quick Reference Guides page of the public Web Portal, for instructions on how to submit an electronic exceptional claim.
  • Each exceptional claim should have its own cover sheet [107KB PDF]
  • Hurricane Ian Request for Exceptional Claims Processing
    • Each hurricane Ian related exceptional claim requires this specific coversheet.
    • Hurricane Ian related exceptional claims can be submitted electronically or via paper claim to Exceptional Claims Processing, P.O. Box 7080, Tallahassee, FL 32314-7080
  • COVID-19 Request for Exceptional Claims Processing for dates of service effective March 9, 2020. The waiver of service limits continues until further notice for behavioral health services.
    • Effective July 15, 2021, Medicaid prior authorization requirements were reinstated for behavioral health services.
    • COVID-19 related exceptional claims can be submitted via paper claim or electronically
    • Each COVID-19 related exceptional claim requires this specific COVID-19 cover sheet.

Additional Reference Information

Children’s Medical Services Health Plan

Children’s Medical Services Health Plan (CMS Health Plan) is a Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA) Specialty Plan for children and youth with special health care needs. This plan is offered by the Florida Department of Health who has contracted with WellCare of Florida, Inc to provide managed care services to our members.  You can visit www.CMSPlanFlorida.gov to learn more.

If you are the treating physician of a child and you would like to attest to the eligibility of your patient for the CMS plan, please review the CMS Clinical Eligibility Attestation for Physicians and a list of qualifying chronic and serious conditions. Completed and signed attestations can be submitted by the physician to the Department of Health via secure email at CMS.ClinicalEligibilityScreening@flhealth.gov or via fax to 850-488-3813. Please be sure to submit all five pages of the attestation.

If physicians have questions about the CMS Clinical Eligibility Attestation, please contact a CMS plan nurse at 1-855-901-5390.

Florida Medicaid contracts with a Fiscal Agent for provider enrollment, management of the beneficiary file/records Medicaid Fee-For-Service claims processing and payment.

Florida Medicaid contracts with the following entity to perform Prior Authorization/Utilization Management services.