59G-4.001: Medicaid Providers Who Bill on the CMS-1500
PURPOSE AND EFFECT: The purpose of this rule amendment is to incorporate by reference in rule the revised Florida Medicaid Provider Reimbursement Handbook, CMS-1500, July 2008. The revised handbook includes paper claim billing instructions for home and community-based waiver services and targeted case management services. The revised handbook also includes information on the new Medicaid fiscal agent, Electronic Data Systems (EDS), and the new Medicaid computer system. In addition, the handbook contains updated billing instructions for entering National Drug Codes on claims for HCPCS codes for drugs and for entering prior authorization numbers for Medical Foster Care and Prescribed Pediatric Extended Care Center Services. The effect will be to incorporate by reference in rule the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, July 2008.
In the Notice of Rule Development, published in Vol. 33, No. 48, Florida Administrative Weekly, dated November 30, 2008, we stated that the handbook effective date was March 2008. We changed this date to July 2008.
SUMMARY: The purpose of this rule amendment is to incorporate by reference in rule the revised Florida Medicaid Provider Reimbursement Handbook, CMS-1500, July 2008. The effect will be to incorporate by reference in rule the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, July 2008.
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: 409.905, 409.908, 409.9081 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(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: Monday, October 6, 2008, 3:30 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building #3, Conference Room B, Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Karen Girard, Agency for Health Care Administration, Bureau of Medicaid Services, 2727 Mahan Drive, Building 3, Mail Stop 20, Tallahassee, Florida 32308-5407, (850)488-9711, girardk@ahca.myflorida.com
THE FULL TEXT OF THE PROPOSED RULE IS:
59G-4.001 Medicaid Providers Who Bill on the CMS-1500.
(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 CMS-1500 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, CMS-1500, July 2008 February 2006, updated January 2007 and November 2007, which is incorporated by reference. The handbook is available from the Medicaid fiscal agent’s Web Portal website at http://mymedicaid-florida.com floridamedicaid.acs-inc.com. 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 Contact Center Inquiry at (800)289-7799 377-8216 and selecting Option 7.
(2) The following forms that are included in the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, are incorporated by reference: in Chapter 1, the CMS-1500 Claim Form, Approved OMB-0938-0999 Form CMS-1500 (08-05), one page double-sided; and in Chapter 32, the Healthy Start Prenatal Risk Screening Instrument, DH 3134, 2/01 9/97, one page;. The following forms that are included in Chapter 2 of the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, are incorporated by reference in Rule 59G-4.160, F.A.C.: State of Florida, Florida Medicaid Authorization Request, PA01 07/08 04/2002, one page; Medically Needy Billing Authorization, DF-ES 2902, June 2003, one page; State of Florida, Sterilization Form, HHS-687 (11/2006) SCF 7/94, doublesided one page; Consentimiento Para La Esterilización, HHS-687-1 (11/2006), doublesided; State of Florida, Hysterectomy Acknowledgment Form, HAF 07/1999, one page; State of Florida, Exception to Hysterectomy Acknowledgment Requirement, ETA 07/20081, one page; State of Florida, Abortion Certification Form, AHCA-Med Serv Form 011, August 2001, one page. All the forms except for the Healthy Start Prenatal Risk Screening Instrument are available from the Medicaid fiscal agent by calling the Provider Contact Center Inquiry at (800)289-7799 377-8216 and selecting Option 7 or from its Web Portal website at http://mymedicaid-florida.com floridamedicaid. acs-inc.com. Click on Public Information for Providers, then on Provider Support, and then on Medicaid Forms. The Healthy Start Prenatal Risk Screening Instrument is available from the local County Health Department.
Specific Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912 FS. History–New 10-1-03, Amended 7-2-06, 3-7-07, 4-9-08,_________.