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Medicaid Update: Express Enrollment & Streamlined Credentialing

December 22, 2015 11:30 AM | Amanda Riordan (Administrator)

On December 22, 2015 FAA President Alan Skavroneck received the following information from AHCA Assistant Deputy Secretary for Medicaid Policy & Quality Beth Kidder.

Express Enrollment

Express Enrollment will provide Medicaid recipients with the opportunity to allow new enrollees who are mandated to participate in the Managed Medical Assistance (MMA) program to immediately take advantage of robust provider networks, access standards, and expanded benefits offered by the plan.  Express Enrollment will provide Medicaid recipients with the opportunity to make a plan choice concurrent with eligibility application and assign Medicaid-eligible individuals who are mandated to participate in the MMA program to a health plan immediately after eligibility determination.

The State received approval on the amendment to Florida’s 1115 MMA waiver to allow for Express Enrollment.  The Agency intends to implement Express Enrollment on January 11, 2016.  Express Enrollment does not impact the Long-term Care program and it is not related to streamlined credentialing or limited enrollment for providers.

To access a Snapshot, webinar slides, and a Frequently Asked Questions document with more information on Express Enrollment, please use the following link: http://ahca.myflorida.com/medicaid/statewide_mc/express_enroll.shtml

Streamlined Credentialing for Medicaid Providers

The Agency for Health Care Administration has created a streamlined application, or Limited Enrollment, for providers who do not hold a Medicaid ID and need to complete basic credentialing which may be a prerequisite to seeking a contract with a Medicaid health plan.

With the implementation of Limited Enrollment in December 2015, some providers have the option to utilize a web-based Limited Enrollment application wizard which guides them through creation of the application.  The streamlined application and corresponding review process allows approved providers to receive their Medicaid IDs faster than with traditional full enrollment.

NOTE: Limited Enrollment is not an option for providers of services to fee-for-service recipients. Fee-for-service providers must seek traditional full Enrollment in order to directly bill Medicaid for reimbursement.

For those providers of services solely to recipients in a health plan, Limited Enrollment is a valuable option.

For additional information or assistance with questions related to how this new enrollment type may be of benefit to your providers, please email our Managed Care Analyst for Medicaid Provider Enrollment:

Nick Constantino

Medicaid Fiscal Agent Operations

Agency for Health Care Administration


Limited Enrollment FAQs

  • How do providers submit a Limited Enrollment application?
    Providers will be able to submit a Limited Enrollment application through the Public Web Portal.
  • What does Limited Enrollment capture?
    The Limited Enrollment application captures all demographic information, licensure and exclusion databases verification, and background screenings in compliance with Affordable Care Act provider screening requirements.
  • When will Limited Enrollment be available?
    Limited Enrollment will be available in December, 2015.
  • How does Limited Enrollment affect Provider Registration?
    Providers that go through the Limited Enrollment process do not need to “register.” Registration should be reserved for the use of health plans to obtain Medicaid IDs for non-participating providers.
  • Who should apply to become a Limited Medicaid provider?
    Limited Enrollment is an option for providers who will only be paid by a health plan. Providers who wish to submit claims directly to Florida Medicaid for fee-for-service reimbursement, should apply for regular Enrollment.
  • Can a Limited Medicaid provider bill fee-for-service?
    Like Registered Medicaid providers, a Limited Medicaid provider cannot bill fee-for-service claims.
  • How often does Limited Enrollment need to be renewed?
    Limited providers will be required to complete a renewal process every three (3) years, similar to the current renewal process for Enrolled providers.
  • If I am a Registered provider, do I have to become a Limited Medicaid provider?
    Registered providers are not required to seek Limited Enrollment but can choose to go through the Limited Enrollment process.  By meeting the additional credentialing elements included within the Limited Enrollment process (such as background screening), providers may experience additional efficiencies when seeking credentialing by health plans.
  • If I am a Limited Medicaid provider, can I later become an Enrolled Medicaid provider in order to bill fee-for-service?
    Yes. Limited Medicaid providers can submit a new application to seek to become an Enrolled Provider.
  • Who do I contact if I have additional questions about Limited Enrollment?
    Contact the Provider Enrollment Contact Center for additional assistance, at 800-289-7799, option 4.
  • What provider credentialing functions will remain with the health plans?
    Onsite visits, proof of education, training, and work history will remain with the health plans along with any additional criteria as determined by the plans.