Hurricane Michael Emergent Claims Processing
Important provider information regarding reimbursement for services rendered to Prestige Health Choice members impacted by Hurricane Michael.
Disaster Grace Period: October 7, 2018, through October 21, 2018
- No prior authorizations are required for any inpatient or outpatient services.
- Payment will be provided to both participating and non-participating providers for services provided to Prestige Health Choice members during this period.
- In order to be reimbursed for eligible Prestige Health Choice members for dates of service within this period, providers not already enrolled in Florida Medicaid (out-of-state or in-state) must complete a provisional (temporary) enrollment application. The process for provisional provider enrollment is located at the Agency for Health Care Administration (AHCA) Hurricane Michael information page. Please refer to the Provisional Provider Enrollment section below for additional information.
- Usual service limitations will not be applied during this period.
Starting October 22, 2018, prior authorizations will be reinstated for inpatient and outpatient services.
Outside of the Disaster Grace Period (beginning October 22, 2018, until further notice)
In those instances where a provider and/or member could not comply with policy requirements because of ongoing storm-related impact, Prestige Health Choice will continue to reimburse for:
- Services furnished after the disaster grace period without prior authorization and without regard to service limitations.
- Services provided by a current Medicaid-enrolled provider in those instances where the provider and/or member could not comply with policy requirements because of ongoing storm-related impacts.
Providers must have rendered services in good faith to maintain the member’s health and safety. Examples of such instances include:
- Provider still does not have access to the Internet or phone services as a result of continued power outages, therefore could not request prior authorization timely.
- The member continues to be displaced and must receive services in a different region of the state or out of state.
- The member’s assigned PCP or specialist’s office remains closed due to the storm, and urgent care is rendered at another provider’s location without prior authorization.
- In order to be reimbursed for eligible Prestige Health Choice members for dates of service within this period, providers not already enrolled in Florida Medicaid (out-of-state or in-state) must complete a provisional (temporary) enrollment application. The process for provisional provider enrollment is located at the AHCA Hurricane Michael information page. This process should be completed PRIOR to submitting your claim to the Prestige Health Choice Claims Payment Exception Process.
Provider provisional enrollment
If a Provider and Billing Group DOES NOT Have a Florida Medicaid Number, you MUST FIRST apply for a Florida Medicaid ID.
To Apply for your Florida Medicaid Number:
For Medicaid providers within the State of Florida that are not enrolled with Florida Medicaid, along with out-of-state providers who are providing services to displaced Florida residents, Florida Medicaid is waiving the requirements to submit documentation showing the nature of the treatment, as well as other normally-required information. Until further notice, Florida Medicaid will only require the following:
- A fully completed claim form containing the provider’s active National Provider Identifier (NPI), along with the provider’s SSN/FEIN (this claim will not be reimbursed by AHCA, it is being used by AHCA as part of their provider provisional enrollment process only after you receive your provisional provider number, you will need to resubmit this claim to Prestige Health Choice for claims processing and reimbursement).
- A signed Florida Medicaid Provider Agreement (MPA):
- A copy of the provider’s professional license.
- An optional signed Electronic Funds Transfer (EFT) Authorization Agreement (PDF), if providers choose to receive payment electronically.
After obtaining your Provider and/or group Florida Medicaid ID number from the state of Florida, you will then need to complete the Prestige’s provider registration form (PDF). This registration form will assist Prestige Health Choice in setting you up in the Prestige Health Choice claims payment system so that we can process your claims appropriately.
Once you have completed this form, please fax the completed form to 1-844-518-2552 or email to PHCPNORequests@prestigehealthchoice.com. In addition to this form, Prestige Health Choice will also need the following documentation:
- A complete and signed W9.
- A copy of your AHCA letter indicating your Florida Medicaid provider and group Medicaid IDs.
- A copy of 1 claim for provider setup purposes (this claim will not be forwarded to claims).
Prestige Health Choice claims payment exception process
Prestige Health Choice will reimburse for a medically necessary service that was provided to an impacted Prestige Health Choice member DURING the designated disaster grace period (10/7/2018 through 10/21/2018) for the following:
- The service(s) would have required a prior authorization.
- The service(s) was rendered by a non-participating provider.
- The service(s) exceeded normal policy limits for the service(s).
During this designated disaster grace period, providers should follow the usual Prestige Health Choice claims submission process.
For medically necessary service(s) that were provided to an impacted Prestige Health Choice member OUTSIDE of the designated disaster grace period (beginning 10/22/2018 and until further notice) to be considered for reimbursement by the Plan, the provider MUST submit the following information:
- A completed Prestige Health Choice Claims Exception Form (PDF).
- A contact name, telephone number, and email address for the provider/provider office.
- A copy of the Agency’s letter reflecting your Medicaid provisional enrollment number.
- A paper provider claim to ensure proper processing.
Please note that for this claims payment exceptions process, Prestige Health Choice’s process will include the waiver of non-applicable provider credentialing requirements.
Please provide all documentation in hard copy. All information should be sent to:
Prestige Health Choice
Claims Exception Process-Hurricane Michael
11631 Kew Gardens Avenue, Suite 200
Palm Beach Gardens, FL 33410
For any questions regarding the claims payment exception process for Hurricane Michael, please call 1-888-599-1476 or email your question to HurricaneClaimExceptionProcess@prestigehealthchoice.com.