See if the service you provide is reimbursable. How to provide acute and primary medical resources that continue to meet members’ needs. You are using an outdated browser. Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus (2019-nCoV). Visit the HHS website for more information. These providers must go through the provisional enrollment process, if they are not already enrolled in Florida Medicaid. 15 minutes); H2019 Management (intervention) (1 unit = 15 minutes), S9123 Intermittent and skilled nursing, RN (per hour) Examples of services include: the 45-day hospital inpatient limit, home health services, durable medical equipment, in-home physician visits, $1,500 outpatient limit, etc. This information is not a complete description of benefits. Providers must obtain approval from Sunshine Health prior to providing adult community support services. State-sponsored Medicaid benefits for eligible Floridians. These members already received a letter from the Agency notifying them that their coverage was ended, but they will receive a second letter from the Agency notifying them of this extension. Providers must utilize appropriately licensed staff to perform services within the individual’s scope of practice. These costs can quickly add up, especially for patients who do not have out-of-network benefits. Managing the Threat of the New Coronavirus Strain. However, for full-dual beneficiaries, the State will cover your Part B premium as long as you retain your Medicaid eligibility. For additional information and guidance on COVID-19 billing and coding, please visit the resource centers of the Centers for Medicare and Medicaid (CMS) and the American Medical Association (AMA). Enrollment in Allwell depends on contract renewal. Other symptoms include fatigue, sputum production, and muscle aches. Effective immediately, the following service providers are temporarily eligible to render additional LTC medically necessary services in a member’s home until further notice. Contract Request Form . Learn More. Read provider coronavirus guidance. You will receive notice when necessary. We will not reimburse for well-child visits performed via telemedicine for children 24 months and younger. There is a maximum of two per lifetime. (By clicking on the links below you will be leaving your plan's Allwell Medicare Advantage site. If you have questions regarding this communication, or are interested in providing or learning more about any of the expanded services, please call Provider Services at 1-844-477-8313. While we continue to connect our members to COVID-19 services, we wanted to reach out to our provider partners on how we can work together to better support their care needs. Providers may experience higher than normal wait times when calling Provider Services so we encourage providers to use the web portal for eligibility, claims submission, etc. Medicaid Managed Long Term Care for Medicaid enrollees 18 years and older who meet Nursing Facility level of care. Our site has been designed to help you get your job done.Manage all products with ease in one location. The service must be completed in its entirety, as detailed in the EIS coverage policy and fee schedule. For example, a home health aide cannot perform a skilled nursing task. You can also submit claims, view authorizations and schedule visits through this portal. Sunshine Health is a Florida Medicaid health plan that has been providing services in Florida since 2009. To ensure that our Long Term Care members are able to receive all services necessary to maintain their health, safety and welfare during the COVID-19 state of emergency, the Agency for Health Care Administration (AHCA) has temporarily expanded the services that certain LTC Service Providers can perform. Please talk to your eligible patients about whether the vaccine is right for them. Registration is fast and simple, give it a try. Temporary Expansion of LTC Service Providers. The Sunshine Health provider directory is a list of physicians, hospitals and other healthcare providers that are available to you. Download the free version of Adobe Reader. Hospital services (including long-term care hospitals), Advanced practice registered nursing services, Ambulance transportation, except when related to transfers prior to admission (as listed in the July 9, 2020, update above), There is a compelling suspicion of fraudulent activity, A provider was previously placed on pre-payment review due to aberrant billing activity, Durable medical equipment requires customization. Sunshine Health is a Florida Medicaid health plan that has been providing services in Florida since 2009. Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. During this public emergency, early intervention screenings and evaluations (initial and follow-up) may be provided via telehealth when the service is delivered in accordance with federal and state law requirements (e.g., multidisciplinary team requirements can be met through live, two-way audio and video capabilities). Ron DeSantis’ Plan for Florida’s Recovery and guidelines from the Agency for Health Care Administration (AHCA). Below is a list of our 2015 dental providers for the coverage timeframe of January 1, 2015-December 31, 2015. If you have any questions about this extension or the covered benefits impacted by it, please contact Provider Services at 1-844-477-8313. You will need Adobe Reader to open PDFs on this site. We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS), the Florida Department of Health (DOH), the Agency for Health Care Administration (AHCA), and all other applicable agencies as it is released to ensure we can quickly address and support the prevention, screening and treatment of COVID-19. Providers wishing to render this service should first contact Sunshine Health to discuss service delivery. Please note that a new browser window will open. The member must request that the pharmacy dispense a 90-day supply. However, be aware that infected individuals can be contagious before symptoms arise. This guidance is in response to the current COVID-19 pandemic and may be retired at a future date. If providers have already received a retainer payment for three months, Sunshine Health will not make retainer payments in subsequent months. Any uncovered services will be denied. Continuation of zero member liability (copayments, coinsurance and/or deductible cost sharing) for care delivered via telehealth, Any services that can be delivered virtually will be eligible for telehealth coverage, All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through October 25, 2020, Telehealth services may be delivered by providers with any connection technology to ensure patient access to care. For existing patients, providers should use the CR modifier with one of the following procedure codes: 99441, 99442, 99443, or 99441 CG, For new patients, providers should use the CR modifier with one of the following procedure codes: 99442 CG or 99443. Providers performing high production COVID-19 diagnostic testing via high-throughput technology can bill us for testing services that occurred after February 4, 2020, using the following newly created HCPCS codes: Neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies. How to Create Positive New Habits in our New World, Medicaid Supplemental Preferred Drug List, Diagnostic Testing Guidelines for 2019 Novel Coronavirus – COVID-19 (PDF). Sunshine Health has developed the expertise to work with Medicaid and Long Term Care members to improve their health status and quality of life through the provision of quality services to meet the care needs of members. The Florida Medicaid Management Information System (FMMIS) is expected to be accurate as of April 1, 2020. We are complying with the rates published by CMS for the following codes: Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available. We will reimburse for a 90-day supply of maintenance prescriptions. We may delay payment and require proof of medical necessity when: We are waiving limits on medically necessary services (specifically related to frequency, duration and scope) that need to be exceeded in order to maintain the health and safety of members diagnosed with COVID-19 or when it is necessary to maintain a member safely in their home. Please note: It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020. Providers must obtain approval from Sunshine Health prior to providing adult community support services. During the state of emergency and until otherwise advised, we will not deny payment based upon the lack of completion of PASRR requirements for new admissions to a nursing facility. For Providers; For Agents; Sunshine Health; A A A. If qualified providers have previously received approval to receive a retainer payment and have not exceeded the three-month limitation – and have not exceeded the three-month limitation – Sunshine Health will continue to make the payments until the three-month limit is reached. Some providers may not perform certain services based on religious or moral beliefs. Every year, Medicare evaluates plans based on a 5-star rating system. All rights reserved. In order to ensure that all of our members have needed access to care, we have increased the scope and scale of our use of telehealth services for all products for the duration of the national COVID-19 public health emergency. The needed change in service delivery must be documented in the member’s plan of care. Once you are no longer receiving a retainer payment, you may begin submitting claims based on care plan authorization and member’s utilization of services. This includes speech language pathology, and physical and occupational therapy. Read the clinical policy for Diagnostic Testing Guidelines for 2019 Novel Coronavirus – COVID-19 (PDF). Providers billing with these codes will not be limited by provider type and can be both participating and non-participating. The provider must guide the caregiver in the implementation of certain components of the recipient’s treatment plan to promote carryover of treatment gains. Enrollment in Allwell depends on contract renewal. Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposure in Travel-associated or Community Settings. Additional guidance for our Medicaid Providers. Payment parity: For telehealth visits that include audio and video, we will pay providers the same rates they would receive for a similar face-to-face visit. (Updated 06/16/2020). When service limits have been exceeded for members receiving services, providers must submit medical necessity through our standard authorization process. How to Create Positive New Habits in our New World, Medicaid Supplemental Preferred Drug List, Medicaid Provider Directory - Region 1 (PDF), Medicaid Provider Directory - Region 2 (PDF), Medicaid Provider Directory - Region 3 (PDF), Medicaid Provider Directory - Region 4 (PDF), Medicaid Provider Directory - Region 5 (PDF), Medicaid Provider Directory - Region 6 (PDF), Medicaid Provider Directory - Region 7 (PDF), Medicaid Provider Directory - Region 8 (PDF), Medicaid Provider Directory - Region 9 (PDF), Medicaid Provider Directory - Region 10 (PDF), Medicaid Provider Directory - Region 11 (PDF).
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