Medicaid provider Enrollment overview

Who Must Enroll
To receive Medicaid reimbursement, a provider must be enrolled in Medicaid and meet all provider requirements at the time the service is rendered. Every entity that provides Medicaid services to recipients or billing services of any kind to Medicaid providers must enroll as a Medicaid provider.

Enrollment Qualifications

Providers must meet all the provider requirements and qualifications and their practices must be fully operational before they can be enrolled as Medicaid providers.

Tax ID Number

The provider applicant must enter his tax identification (ID) number on the Enrollment Application and attach a signed W-9 form, proof of federal tax identification number, or a copy of his Social Security Number.

An individual provider’s tax ID number is either his Social Security Number or federal tax ID if he is incorporated. An individual cannot enroll using the group’s tax ID number as his individual tax number.A group provider or facility’s tax identification number is the federal tax ID number that the Internal Revenue
Service (IRS) assigned to the group, entityor corporation.

IRS requires Medicaid to generate IRS 1099 forms for all providers to whomreimbursement is issued. (Tax-exempt providers do not receive 1099 forms,e.g. Medical Foster Care.) The provider’s tax ID number must be correct onthe Medicaid computer system for the IRS 1099 form to be correctlygenerated.

Medicare Certification

The following providers must be Medicare certified to enroll as Medicaid providers and to remain enrolled:
• Ambulatory Surgical Centers
• Freestanding Dialysis Centers
• Hospices
• Hospitals
• Rural Health Clinics
• Portable X-ray Providers
• Skilled Nursing Facilities

CLIA Certification 

Providers with laboratories must be certified under the Clinical Laboratory Improvement Act (CLIA) for the tests that they perform to enroll as Medicaid providers and to remain enrolled.

Required Enrollment Forms and Documentation

To enroll in Medicaid, non-institutional provider applicants must submit the following forms and documentation.

• Medicaid Provider Enrollment Application;
• Non-Institutional Medicaid Provider Agreement;
• Fingerprint Card or FDLE Criminal History Check and Fingerprinting Exemption Request;
• Surety Bond Form or Certification of Ownership Form for Physician Groups, if applicable;
• Authorization Agreement for Electronic Funds Transfer or Exemption Request;
• Copies of required licenses, certifications, and other required documentation; and
• Any other information that is requested in the enrollment package.

The provider must keep a copy of the application form and attachments for his own records. Legible photocopies of the application forms or printed forms from the Internet with original signatures are acceptable.

How to Obtain Enrollment Forms

Enrollment forms can be obtained from the Medicaid fiscal agent by writing or calling:

ACS - Florida Medicaid
Provider Enrollment
P. O. Box 7070
Tallahassee, Florida 32314-7070
PH - 800-377-8216

Where to Submit the Enrollment Package

The Provider Enrollment application contains the addresses for specific provider types to submit the completed enrollment package and required documentation.

Effective Date of Enrollment

The effective date of enrollment is the date the provider application is approved.

Medicaid does not enroll providers retroactively. A provider should not bill until it receives confirmation from Medicaid that it is enrolled in Medicaid, has received its Medicaid provider number, and confirmation of the effective date of the enrollment.

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