59G-4.003: Medicaid Providers Who Bill on the UB-04
PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.003, F.A.C., is to incorporate by reference the Florida Medicaid Provider Reimbursement Handbook UB-04, June 2012. The handbook contains policies and instructions related to claims for reimbursement by certain, identified provider types. The policies and instructions are applicable to claims submitted on the UB-04 paper claim form, and to claims submitted electronically. The revisions contemplated include the following: additional billing instructions specifically for Nursing Facilities, Intermediate Care Facilities, and State Mental Hospitals; updated references for the new Medicaid fiscal agent; and updated prior-authorization requirements for certain diagnostic imaging procedures.
SUBJECT AREA TO BE ADDRESSED: Medicaid Providers Who Bill on the UB-04.
An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-4.003, F.A.C., will have as provided for under Sections 120.54 and 120.541, F.S.
RULEMAKING AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: Wednesday, April 18, 2012, 10:00 a.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room A, Tallahassee, Florida 32308-5407
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Arabella Reeves at the Bureau of Medicaid Services, (850)412-4206. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Arabella Reeves, Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: (850)412-4206, e-mail: arabella.reeves@ahca.myflorida.com
THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:
59G-4.003 Medicaid Providers Who Bill on the UB-04.
(1) All Medicaid providers and their billing agents who submit claims on behalf of an enrolled Medicaid provider, who are required by their service-specific coverage and limitations handbook or other notification by the Medicaid Program to bill the Florida Medicaid Program on a paper UB-04 claim form for reimbursement of services performed on a Medicaid eligible recipient, must be in compliance with the provisions of the Florida Medicaid Provider Reimbursement Handbook, UB-04, June 2012 July 2008, which is incorporated by reference. The handbook is available from the Medicaid fiscal agent’s Web site Portal at www.http://mymedicaid-florida.com. Select Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. Paper copies of the handbook may be obtained by calling the Provider Services Contact Center at 1(800)289-7799 and selecting Option 7.
(2) The following form that is included in the Florida Medicaid Provider Reimbursement Handbook, UB-04, is incorporated by reference: in Chapter 1, the UB-04 CMS-1450, Approved OMB No. 0938-0997, May 2007, one page double-sided. The form is available from the Medicaid fiscal agent’s Provider Contact Center by calling 1(800)289-7799 and selecting Option 7.
Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History– New 10-2-07, Amended 2-25-09,________.