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.
Referrals Requirements to In-Network Specialists - Effective: 02/01/18
Molina Healthcare of Florida, Inc. (“Molina”) PCPs serve an important role in supporting Molina members’ healthcare, including the coordination of specialty care when appropriate. Although Molina’s member handbooks for all lines of business require a PCP referral when accessing specialty care, Molina has only encouraged coordination between providers with no required supporting documents or forms. Effective February 1, 2018, Molina will begin requiring a paper referral form that should be made available to Molina members, and collected by the specialist office in advance of, or on the date of, the specialist visit.
This change will allow Molina and its network PCPs to promote primary care, and better coordinate specialty care at the right time and in the right setting. The referral requirement does not affect Molina’s Prior Authorization guidelines. Therefore, services that require prior authorization will continue to require clinical review and prior approval by Molina, and will not be reimbursed with a referral. Specialists should continue to submit requests for services that require prior authorization, and should not refer members to their PCP for authorization requests.
For more information click HERE.
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.