All Third-Party Billing Agents and Clearinghouses Must Register with Medicaid

Date: 11/02/23

Fort Lauderdale, Florida

AHCA requires all third-party vendors that providers contract with as a billing agent or clearinghouse to enroll as a Medicaid provider. Vendors must also be linked to the providers they service.

Providers must also make sure to complete an Electronic Data Interchange (EDI) Agreement with third-party vendors they contract with as a billing agent or clearinghouse, whether the provider bills on paper or electronically. An EDI Agreement authorizes Florida Medicaid to allow the third-party vendor to act on behalf of the Medicaid provider.

These state rules are designed to combat and prevent abuse, fraud and waste in the Florida Medicaid program.

For Florida Medicaid Help and Information

Find more information about the AHCA requirements discussed in this communication:

• Florida Medicaid Provider Enrollment Policy (PDF)
• Electronic EDI Agreements Quick Reference Guide (PDF)

If you need help with the Florida Medicaid program, call 1-877-254-1055 or email FLMedicaidManagedCare@ahca.myflorida.com.

Complete an EDI Agreement

Providers can complete an EDI agreement by logging into their Florida Medicaid account using the Florida Medicaid Web Portal. From the secure Web Portal landing page, select Providers, then under the Providers option, select demographic maintenance. From the Provider Informational panel, select EDI Agreement. If you need help, call the EDI Helpdesk at 1-866-586-0961.

Questions?

If you have questions, please contact your Provider Engagement Administrator, call Wellcare Provider Services at 1-855-538-0454 or visit Wellcare.com/Florida. Stay up to date on Wellcare provider notices by reviewing and bookmarking Provider Bulletins.

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