Florida Medicaid: Get prepared for EPNA audits

UnitedHealthcare Community Plan providers in Florida may receive secret shopper calls or on-site visits through the Florida Agency for Health Care Administration’s (AHCA) Enhanced Provider Network Auditing (EPNA) program. The program helps evaluate provider directory accuracy, appointment access, provider availability and overall member experience.

To help your office prepare, review call-handling and scheduling procedures with staff and confirm your information is accurate and up to date.

Focus on these areas:

Medicaid participation: Confirm staff members know whether your practice accepts UnitedHealthcare Medicaid and if you’re accepting new patients
Scheduling: Provide the next available appointment when requested, and avoid unnecessary scheduling barriers
After-hours access: Review after-hours procedures and ensure voicemail messages include appropriate urgent-care guidance
Directory accuracy: Verify practice names, addresses, phone numbers, specialties and provider listings are accurate through CAQH or My Practice Profile
Call handling: Ensure staff can accurately communicate provider participation and availability
Capacity and access: Confirm your location is open, receiving patients and performing services as reflected in provider directories

Taking a few moments to review these items with your staff can help reduce audit findings and support a better experience for members seeking care.