credentialing services

Updated Humana Medicaid Regs in Florida

We received this correspondence and thought it was worth sharing to ensure all Florida groups are aware of the changes.  Please contact us if you have any questions about this or other credentialing concerns.


From Humana:

Beginning April 10, 2017, claims will be denied for physicians and healthcare professionals with invalid Medicaid enrollment. To receive Medicaid reimbursement, a physician or health care professional must be fully enrolled in Medicaid or have “limited enrollment status,” as well as meet all provider requirements at the time the service is rendered. Any entity that bills Humana for Medicaid-compensable services provided to Medicaid recipients or that provides billing services of any kind to Medicaid providers must enroll as a Medicaid provider.

Physicians and other healthcare professionals can verify their enrollment via the AHCA website:

Please note the following details regarding how the physician or healthcare professional should be listed:

  • A current listing of Medicaid numbers for ALL providers must be CONFIRMED ACTIVE ON AHCA PORTAL Provider Master List (PML).
  • The provider must be listed as “ENROLLMENT” or “Limited Enrollment” in Enrollment Type column L and as ACTIVE (A) in Current Medicaid Enrollment Status column V.
  • Provider’s billing NPI and/or rendering NPI must be accurate and affiliated with the provider’s Medicaid ID.

Incorrect enrollment can affect the way a physician, health care professional or provider group is identified by AHCA and its Choice Counselors, as well as how a physician, health care professional or provider group is listed in Physician Finder, Humana’s online provider directory.

AHCA’s Provider Enrollment area is available to assist the physician or health care professional with enrollment issues, such as change of address, change of ownership and re-enrollment issues via the AHCA website:

Guidelines on how physicians and other healthcare professionals should enroll with Medicaid can be found in the Provider General Handbook’s Reference Chapter 2:

If you have questions about these changes, please call your Humana or IASIS provider relations representative.

Thank you for your continued care of our members.