For Medicaid Clients. All Medicaid covered services are to be billed to the Medicaid Managed Care entity in which the child is enrolled, in accordance with the rules and regulations of said organization. Enrollment in Medicaid Managed Care Organizations: All Providers must attempt to enroll with all Medicaid Managed Care programs in their region prior to providing any services and providers will submit to H.P.C. documentation of the attempts to enroll if unsuccessful. Providers may choose to enroll under the MMA plan contract with HPC when that option is available. Please indicate your enrollment decisions on the form Third Party Insurance Participation Status (attachment 8). Out of network commercial insurance billing: The Provider will submit documentation to H.P.C. with the monthly invoice, of attempts to authorize services and enroll with a child’s third party insurance carrier or within 30 days of the date of authorization of services on the child’s IFSP. With the following exceptions: Submitting out of network billing: Providers will submit billing to Medicaid Managed Care plans and third party insurance as out of network providers if they are unable to enroll in the network.
For Medicaid Clients. All Medicaid covered services are to be billed to the Medicaid Managed Care entity in which the child is enrolled, in accordance with the rules and regulations of said organization. Enrollment in Medicaid Managed Care Organizations: All Providers must attempt to enroll with all Medicaid Managed Care programs in their region prior to providing any services and providers will submit to H.P.C. documentation of the attempts to enroll if unsuccessful. Providers may choose to enroll under the MMA plan contract with HPC when that option is available. Please indicate your enrollment decisions on the form Third Party Insurance Participation Status (attachment 8). Out of network commercial insurance billing: The Provider will submit documentation to H.P.C. with the monthly invoice, of attempts to authorize services and enroll with a child’s third party insurance carrier or within 30 days of the date of authorization of services on the child’s IFSP. With the following exceptions: ITDS and BCBS: If you are enrolled as an ITDS you do not have to attempt to enroll with or submit out-of-network billing to Blue Cross and Blue Shield as we have documentation that they will not accept your claim. Submitting out of network billing: Providers will submit billing to Medicaid Managed Care plans and third party insurance as out of network providers if they are unable to enroll in the network. Submission of claims: The provider agrees to xxxx any identified third party payer within sixty (60) days of date of service according to the terms and conditions of said payer source. Natural Environment Support Fee: The Provider will only xxxx for the Natural Environment Support Fee (NESF) when an authorized service is provided in the natural environment. Travel Requirements: Travel claims will be paid in accordance with the Department of Financial Services Travel Manual. The Provider must maintain and submit evidence of a valid State of Florida motor vehicle operator license and valid automotive insurance (declaration page). Updated copies of these documents MUST be submitted to H.P.C. as soon as they are received, any break in valid coverage will result in a suspension of the Provider’s approval to travel to provide services. Travel reimbursement claims must be submitted on a signed state travel voucher (located on the HPC website).
For Medicaid Clients. All Medicaid covered services are to be billed to the Medicaid Managed Care entity in which the child is enrolled, in accordance with the rules and regulations of said organization. Enrollment in Medicaid Managed Care Organizations: All Providers must attempt to enroll with all Medicaid Managed Care programs in their region prior to providing services and providers will submit to H.P.C. documentation of the attempts to enroll if unsuccessful. Providers may choose to enroll under the MMA plan contract with HPC when that option is available. Please indicate your enrollment decisions on the form Third Party Insurance Participation Status (attachment 11). Out of network billing: Providers will submit billing to Medicaid Managed Care plans and third party insurance as out of network providers if they are unable to enroll in the network. Submission of billing within 60 days: The Provider agrees to bill any identified third party payer within sixty (60) days of date of service according to the terms and conditions of said payer source, and to report the intervention to H.P.C. on the Service Log (attachment 7). Natural Environment Support Fee: The Provider will only bill for the Natural Environment Support Fee (NESF) when an authorized service is provided in the natural environment. Minimizing travel: The Provider will make every effort to group clients together to avoid multiple trips to and from their home/office. When performing multiple evaluations with the team, the team will make all efforts to drive together in one vehicle. Invoice Deadline: The invoice to H.P.C. including the Service Log (attachment 7), the Third Party Denial List (attachment 8), the Travel Voucher (attachment 3) and any third party denials, is due to H.P.C. on the first day of each month. Invoices received after the third of the month will be considered late and payment maybe delayed or held until the end of the fiscal year. Invoices that are received 60 days after the date of service will not be paid. Monthly Service Period: The service period to be submitted with each monthly invoice covers the period from the 16th of a month to the 15th of the following month, giving the Provider two weeks to prepare the documentation for submission.
