12/29/2022
Medically_Needy is a share of cost Medicaid the Safety net program (CMS grant) and SUFS can help pay for the share of cost. How to bill Share of cost.
Medikids 1-4 years: Administers Medicaid services and the MediKids program for children ages 1 through 4. The Agency also works with the federal government to make sure the Florida KidCare program follows all federal laws and rules.
Florida KidCare 5-18 years:
Florida Children's Health Insurance Program (CHIP) Income table
DCF: Determines eligibility for the Medicaid program and administers the Behavioral Health Network for children ages 5 through the end of age 18 with serious emotional disturbances.
Medikids or/to Florida KidCare: is the umbrella brand for the four government-sponsored health insurance programs – Medicaid, MediKids, Florida Healthy Kids and the Children's Medical Services (CMS) Health Plan – that together provide a seamless continuum of coverage for Florida children from birth through the end of age 18.
Medically needy billing is different. ONLY be faxed for billing Fax number(s) for DCF: (General Medicaid policy 2.7.2)
1-866-325-6023
1-866-940-7126
1-888-254-7591
Once you have faxed them, Must follow up with them to confirm the bill for payment. (Can take up to 24-48 hours to post)
Parents/caregiver
Medikids or/to Florida KidCare: The parents/caregiver must provide you with ACCESS Case # and Medicaid Pin # to bill if the medicaid is under status as enrolled with coverage type Medically_Needy. (to the Vendor)
Case #
Medicaid Pin #
Cover Letter for Share of Cost: https://bit.ly/3WX8TeO
No prior Authorization is required, BUT just to be safe we should use the billing codes for Medicaid:https://ahca.myflorida.com/medicaid/review/Reimbursement/2022-01-01_Fee_Sched_Billing_Codes/BA_Services_2022_Fee_Schedule.pdf
Have this ready if requested as a form of prior Authorization along with POC: http://fl.eqhs.com/LinkClick.aspx?fileticket=_i5OTB-41jo%3d&tabid=704&mid=1455
Florida Regions:
Northwest Region - Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, and Washington counties - Fields 1 and 2
Northeast Region - Alachua, Baker, Bradford, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Lafayette, Levy, Madison, Nassau, Putnam, St. Johns, Suwannee, Taylor, Union, and Volusia counties - Fields 3, 4, and 12
Central Region - Brevard, Citrus, Hardee, Hernando, Highlands, Lake, Marion, Orange, Osceola, Polk, Seminole, and Sumter counties - Fields 7, 13, and 14
Suncoast Region - Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough, Lee, Manatee, Pasco, Pinellas, and Sarasota counties - Suncoast Field (23) and Field 8
Southeast Region - Broward, Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie counties - Fields 9 and 10
Southern Region - Dade and Monroe counties - Field 11
Critical Need: Waiver Support Coordination: 65G-4.017 Establishing Eligibility. Autism Rule & DX
https://youtu.be/e-Nrv4QHGH8
