Florida Medicaid: Claim and AHCA data must match
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 provider enrollment information as it appears on file with AHCA. Use the Provider Master List (PML) Tip Sheet as a guide in selecting the correct taxonomy for your specialty and to know when to update an NPI Crosswalk Taxonomy.
- 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.
| Remittance denial | Reason | How to correct |
|---|---|---|
N255 |
Billing provider taxonomy missing or invalid on claim |
Submit corrected claim with correct billing provider taxonomy |
N288 |
Rendering provider taxonomy missing or invalid on claim |
Submit corrected claim with correct rendering provider taxonomy |
| N258 | 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 |
| N294 | 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 |
Additional resources
- The Florida Medicaid Taxonomy Guide, found under Enrollment Forms on the Florida Medicaid Web Portal, identifies taxonomies that correlate to provider types and specialties
- FLMMIS Provider Enrollment lists provider types
- Claims, Billing and Payments on UnitedHealthcare Provider Portal to review and resubmit claims
Questions?
Call your provider advocate for more information.
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