(1) All Medicaid providers enrolled in the Medicaid program and billing agents who submit claims to Medicaid on behalf of an enrolled Medicaid provider must comply with the provisions of the Florida Medicaid Provider General Handbook, July 2012, which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-02671 and from the fiscal agent’s Web site at www.mymedcaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks. A paper copy of the handbook may be obtained by calling the Provider Services Contact Center at 1(800) 289-7799 and selecting Option 7.
    (2) The following forms that are included in the Florida Medicaid Provider General Handbook are incorporated by reference. In Chapter 3, Temporary Emergency Medicaid Identification Card, July 2008; CF-ES 2681, Notice and Proof of Presumptive Eligibility for Medicaid for Pregnant Women, Feb 2003; CF-ES Form 2014, Authorization for Medicaid/Medikids Eligibility, Feb 2003; AHCA Form 5240-006, Unborn Activation Form, January 2007; CF-ES 2039, Medical Assistance Referral, Sep 2002. In Chapter 4, AHCA-Med Serv 038, Crossover with TPL Claim and/or Adjustment Form, July 2008; AHCA Form 5000-3527, Medicare Part C-Medicaid CMS-1500 Crossover Invoice, June 2012; AHCA Form 5000-3528, Medicare Part C-Medicaid UB-04 Crossover Invoice, June 2012. Appendix D, AHCA Med Serv Form 2000-0016, Medicaid Out-of-State Prior-Authorization Request Form, January 2012. The CF-ES forms are available from the Department of Children and Family Services. The other forms are available from the Medicaid fiscal agent’s Web site at www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Forms. Paper copies of the forms may be obtained by calling the Provider Services Contact Center at 1(800) 289-7799 and selecting Option 7.
Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History-New 9-22-93, Formerly 10P-5.020, Amended 7-8-97, 1-9-00, 4-24-01, 8-6-01, 10-8-03, 1-19-05, 5-24-07, 2-25-09, 6-13-13.