Florida Payer Configuration and Requirements Tables
The payer configuration table is a valuable resource to help you understand the specific requirements for each payer contract as they relate to the integration process. By referencing this table, you can ensure the correct configuration of payer contracts, maintain compliance, and streamline workflows. Use this topic as a quick reference to verify the scope of each payer’s requirements and to facilitate a smooth integration process.
AHCA FFS
| Payer Configurations and Requirements | AHCA FFS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Not Available |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Children's Medical Services
| Payer Configurations and Requirements | Children's Medical Services |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Florida Community Care
| Payer Configurations and Requirements | Florida Community Care |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Not Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Humana
| Payer Configurations and Requirements | Humana |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Little Havana (LHANC)
| Payer Configurations and Requirements | Little Havana (LHANC) |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Molina Payers
| Payer Configurations and Requirements | Molina Healthcare | Molina Healthcare - MMA |
|---|---|---|
| 835s Availability | Not in Scope | Not in Scope |
| Billing Required | Required | Required |
| Communications Module Availability | Available | Available |
| DX Code is Payer or Provider Managed | Payer Managed | Payer Managed |
| EVV Required | Required | Required |
| Payer GPS Tolerance | 500 ft | 500 ft |
| Missed Visits Required | Required | Required |
| POC Compliance Required | Not in Scope | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope | Not in Scope |
Sunshine Health Plan
| Payer Configurations and Requirements | Sunshine Health Plan |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |