Effective Nov. 1, 2022, if you submit claims with identifier information that doesn’t match your provider enrollment data entered with the Agency for Health Care Administration (AHCA), your claims will be denied.
This requirement follows the mandate the AHCA enacted on March 1, 2022, requiring all health care professionals providing care to Medicaid enrollees to include specific identifiers when filing claims. This requirement also helps ensure we have the proper information needed to promptly pay your claims.
AHCA requirements You must include the following information for billing and rendering providers when submitting claims:
National Provider Identifier (NPI) number, as enrolled with Florida Medicaid
Taxonomy code for your services provided in accordance with your enrolled provider type and specialty
Address with ZIP+4 code, as enrolled with Florida Medicaid
What you need to do Take the following steps to ensure your information is accurate and matches the data recorded with AHCA and UnitedHealthcare Community Plan:
Verify your information matches what you submit on your claims
Resubmitting denied claims If we denied claims you submitted with NPIs and/or taxonomy not in compliance with AHCA requirements, you can submit a claim correction. Use the following chart to know what’s needed to correct your claim based on the remittance denial code and go to our Claims Interactive Guide for instructions on how to submit a claim correction.
How to correct
Billing provider taxonomy missing or invalid on claim
Submit corrected claim with correct billing provider taxonomy
Rendering provider taxonomy missing or invalid on claim
Submit corrected claim with correct rendering provider taxonomy
Billing provider ZIP+4 or street address on claim is invalid
Submit corrected claim with correct billing provider ZIP+4 and/or street address, according to the PML
Service facility provider ZIP+4 or street address on claim is invalid
Submit corrected claim with correct service facility provider ZIP+4 and/or street address, according to the PML
The Florida Medicaid Taxonomy Guide, found under Enrollment Forms on the Florida Medicaid Web Portal, identifies taxonomies that correlate to provider types and specialties