59G-4.003: Medicaid Providers Who Bill on the UB-04
PURPOSE AND EFFECT: The purpose of this rule is to incorporate by reference the Florida Medicaid Provider Reimbursement Handbook, UB-04, May 2007. The Department of Health and Human Services, Centers for Medicare and Medicaid, replaced the UB-92 claim form with the UB-04 claim form effective May 2007. The handbook contains the instructions for the new claim form. The effect will be to incorporate by reference in rule the Florida Medicaid Provider Reimbursement Handbook, UB-04, May 2007.
In the Notice of Rule Development that was published in Vol. 33, No. 11, March 16, 2007, Florida Administrative Weekly, we stated that the handbook was effective March 2007. We changed the date to May 2007.
SUMMARY: The purpose of this rule is to incorporate by reference the Florida Medicaid Provider Reimbursement Handbook, UB-04, May 2007. The effect will be to incorporate by reference in rule the Florida Medicaid Provider Reimbursement Handbook, UB-04, May 2007.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.912 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: Tuesday, July 10, 2007, 2:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building #3, Conference Room D, Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Catherine McGrath, Bureau of Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308, (850)922-7326, mcgrathc@ahca.myflorida.com
THE FULL TEXT OF THE PROPOSED RULE 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, May 2007, which is incorporated by reference. The handbook is available from the Medicaid fiscal agent’s website at http://floridamedicaid.acs-inc.com. Click on Provider Support, and then on Handbooks. Paper copies of the handbook may be obtained by calling the Medicaid fiscal agent at (800)377-8216.
(2) The following forms that are included in the Florida Medicaid Provider Reimbursement Handbook, UB-04, are incorporated by reference: in Chapter 1, the UB-04 CMS-1450, Approved OMB No. 0938-0997, one page double-sided; and in Chapter 2, the State of Florida, Florida Medicaid Authorization Request, PA01 04/2002, one page; Medically Needy Billing Authorization, CF-ES 2902, June 2003, one page; State of Florida, Sterilization Consent Form, SCF 7/94, one page; State of Florida, Hysterectomy Acknowledgment Form, HAF 07/1999, one page; State of Florida, Exception to Hysterectomy Acknowledgment Requirement, ETA 07/2001, one page; State of Florida, Abortion Certification Form, AHCA-Med Serv Form 011, August 2001, one page. All the forms are available from the Medicaid fiscal agent by calling (800)289-7799 or from its website at http://floridamedicaid. acs-inc.com. Click on Provider Support, and then on Medicaid Forms.
Specific Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912 FS. History–New________.