Wiki Florida Medicaid Prior Authorizations

[johnmeyer]

I'm an authorizations specialist for an orthopedic practice in Florida. I'm new to original Medicaid and am verify unfamiliar with it. One of my providers wants to do a shoulder scope on an original Medicaid patient. Does it require prior authorization? If it does, how do I go about requesting authorization? Any help would be greatly appricated.

 

[sls314]

I'm an authorizations specialist for an orthopedic practice in Florida. I'm new to original Medicaid and am verify unfamiliar with it. One of my providers wants to do a shoulder scope on an original Medicaid patient. Does it require prior authorization? If it does, how do I go about requesting authorization? Any help would be greatly appricated.

I used to have to research information on Medicaid in different states for a past employer. One of the great things about working with any state's traditional Medicaid program is that all policies and procedures are publicly available on that state's website. Some state's websites are easier to navigate and find information on than others, of course, but it's all out there in some fashion.

I looked at the Florida Medicaid website and found that the Practitioner Fee Schedule has a column on it for whether any given CPT code requires prior authorizations. That should be a good resource for you. I'm including that link below and also a few additional links below that may be helpful learning and navigating Florida Medicaid.

Fee Schedules (the Practitioner Fee schedule specifically would have the physician codes with the prior authorization column):

Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes

Rule 59G-4.002, Provider Reimbursement Schedules and Billing CodesFee ScheduleEffective DateAssistive Care Services Fee ScheduleUpdated Fee Schedule 2023Updated Fee Schedule July 2022Promulgated Fee Schedule 2022Behavior Analysis Fee ScheduleUpdated Fe...

ahca.myflorida.com

Program rules (this is where you can find any claims billing rules or other policies):

Rules

Rules The Rules Unit is responsible for coordinating and providing support to Florida Medicaid staff related to administrative rules promulgated in the Florida Administrative Code. Emergency Variance/Waiver Petition Below you...

ahca.myflorida.com

Program overview (including how providers can enroll in traditional Medicaid and rules that apply to managed Medicaid in Florida too):

AHCA: Medicaid Landing Page

Medicaid is the medical assistance program that provides access to health care for low-income families and individuals. Medicaid also assists the elderly and people with disabilities with the costs of nursing facility care and other medical and long-t...

ahca.myflorida.com

Hope this helps!

 

[johnmeyer]

I used to have to research information on Medicaid in different states for a past employer. One of the great things about working with any state's traditional Medicaid program is that all policies and procedures are publicly available on that state's website. Some state's websites are easier to navigate and find information on than others, of course, but it's all out there in some fashion.

I looked at the Florida Medicaid website and found that the Practitioner Fee Schedule has a column on it for whether any given CPT code requires prior authorizations. That should be a good resource for you. I'm including that link below and also a few additional links below that may be helpful learning and navigating Florida Medicaid.

Fee Schedules (the Practitioner Fee schedule specifically would have the physician codes with the prior authorization column):

Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes

Rule 59G-4.002, Provider Reimbursement Schedules and Billing CodesFee ScheduleEffective DateAssistive Care Services Fee ScheduleUpdated Fee Schedule 2023Updated Fee Schedule July 2022Promulgated Fee Schedule 2022Behavior Analysis Fee ScheduleUpdated Fe...

ahca.myflorida.com

Program rules (this is where you can find any claims billing rules or other policies):

Rules

Rules The Rules Unit is responsible for coordinating and providing support to Florida Medicaid staff related to administrative rules promulgated in the Florida Administrative Code. Emergency Variance/Waiver Petition Below you...

ahca.myflorida.com

Program overview (including how providers can enroll in traditional Medicaid and rules that apply to managed Medicaid in Florida too):

AHCA: Medicaid Landing Page

Medicaid is the medical assistance program that provides access to health care for low-income families and individuals. Medicaid also assists the elderly and people with disabilities with the costs of nursing facility care and other medical and long-t...

ahca.myflorida.com

Hope this helps!

Thank you by the tons for this! I've been trying to figure this all out for about a month now.