Wednesday, July 30, 2008

Florida Medicaid transitions to EDS with minor bumps

Florida Medicaid made a fiscal agent transition from ACS to EDS (Electronic Data Systems) on July 1st 2008. With this change came a few minor bumps which seems normal with any type of conversion of this scale but it's good for all medical practices that bill electronically to be aware of.

First issue is that reports are reflecting claims accepted but in reality if they are missing NPI numbers they are getting kicked out and are not being processed. For more information on this please reference
Florida Medicaid Claim Rejections

Second issue is that ERA (electronic remittance advice) are not getting transmitted through clearinghouses effectively. If you are not receiving your ERA 835 files please log in to Florida Medicaids website and indicate an agent to receive 835 files (ERA). Florida Medicaid has indicated that medical providers have either not registered for the 835 file or they setup the roles incorrectly causing the ERA no files issue.

1. Go to Florida Medicaid website
2. In provider section tab; select
Secure Information for Providers
3. Sign in to Florida Medicaid using login information
4. Under Applications select: Account Manager

  • Select Add Agent
  • Enter the email address of your clearinghouse
  • Click Search
  • Select available options
  • Terms of Service: Yes, I Agree

5. Under Applications select: Manage Agent Roles

  • Select Provider or Billing Agent (clearinghouse)
  • Select Florida Web Portal
  • Modify the permissions for FLPortalProd
  • Check 835
  • Check Trade Files
  • Save Changes

Electronic Remittance Advice is a electronic explanation of benefits.

Questions on Electronic Medical Billing and Claims then click here medical claims electronic billing

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  1. I have several erroneous denials from Florida Medicaid and I am told by Florida Medicaid the denial is due to a system issue and once the system issue is corrected the claim will be reprocessed. The claim was denied in early December of 2008. Is anyone having issues with denials for cpt code and date of birth issues caused by system errors? The denials are listed below.

    4312 procedure code incompatible with diagnosis code
    4711 Diagnosis code incompatible for recipients age.
    4714 Procedure code age conflict
    4801 These services cannot be billed on this claim form.

  2. Hi M Gomez,

    I wasn't aware of the Florida Medicaid issues however; I did know that Florida of Medicaid was having Part A Crossover issues (they were paying zero). This started happening January 1, 2009 and was fixed on February 6, 2009.

    Thank you for making us aware of this issue and did they tell you when you could re-send the claims through for payment?