AHCA streamlines Medicaid credentialing process

Healthcare providers that do not have a Medicaid provider number, but who are servicing patients through the private insurance industry, now will be able to get a Medicaid ID through a new process being implemented by the Agency for Healthcare Administration.

As of Dec. 4, providers who do not hold a Medicaid ID and need to complete basic credentialing can submit a Limited Enrollment application through the Florida Medicaid public Web Portal.

This streamlined process is designed to allow approved providers to receive their Medicaid IDs faster than with traditional full enrollment, according to ACHA. This is an important step, given Florida’s switch last year to privately managed healthcare for the state’s more than 3 million Medicaid recipients.

This streamlined process does not apply to healthcare providers of fee-for-service recipients, rather it is an option for those who will only be paid by a health plan. Those who directly bill Medicaid for reimbursement must obtain traditional full enrollment.

Limited Medicaid providers will be required to complete a renewal process every three years, similar to the current renewal process for enrolled providers. Those who decide down the road to become enrolled providers can do so by submitting a new application seeking enrolled provider status.

Credentialing functions that remain with the health plans include: onsite visits, proof of education, training, and work history, as well as any additional criteria as determined by those plans.

The Health Law Offices of Anthony C. Vitale can assist in the application process. Give us a call to discuss how we can help you.