Welcome, Florida Healthcare Providers
Contracted providers are an essential part of delivering quality care to our members. We value our partnership and appreciate the family-like relationship that you pass on to our members.
As our partner, assisting you is one of our highest priorities. We welcome your feedback and look forward to supporting all your efforts to provide quality care.
If you have any questions, please call Provider Services at 1-855-322-4076.
Medicare Crossover Claims Policy Change
Effective October 25, 2016, Molina Healthcare of Florida, Inc. ("Molina"), in collaboration with the Agency for Health Care Administration ("AHCA"), will begin accepting crossover claims from the Centers for Medicare and Medicaid Services ("CMS") for dual-eligible, Molina Medicaid members covered by traditional, fee-for-service Medicare. Providers will no longer be required to submit secondary claims to Molina, as the claim will cross over automatically.
This change does not apply to Molina Medicaid members enrolled in a Medicare Part C (Medicare Advantage) plan. Providers must continue to file secondary claims to Molina for these members.
If you have any questions about this communication, please contact Provider Services at (855) 322-4076.
Service Location Requirement for Professional Claims
In order to ensure appropriate reimbursement of professional claims for providers whose contracted fees are based on Medicare rates, Molina Healthcare of Florida will now require service locations on the CMS-1500 form, box 32, and its electronic equivalent.
Medicare rates are determined, in part, by the specific locality in which a service is rendered. Therefore, the service location must be included on the claim to ensure that the correct locality rate is selected during claims adjudication, and reduce miscalculated payments.
If your rates are based on a percentage of Medicare's fee schedule for any contracted line of business, including Medicaid and Marketplace, you must include service locations on your claims as of March 1, 2017. Failure to include service locations on your professional claims may result in claims denials.
If you have any questions regarding this communication, please contact Provider Services at 855-322-4076.