This alert is to remind Florida Medicaid providers that they cannot charge a recipient for Personal Protective Equipment (PPE) used during the delivery of a Medicaid covered service. Reimbursement from Florida Medicaid is payment in full for all services. Additional information, including balanced billing prohibitions, is located in the Agency’s General Medicaid Policy.
It is often difficult, if not next to impossible, to traverse Florida laws on all times relevant for submitting, receiving, contesting, and payment of insurance claims. Florida’s Department of Financial Services (DFS), Office of Consumer Affairs, has helped some in this regard by summarizing part of the payment of claims statute on their website, of which I have incorporated into this article along with other provisions that are not on the website. Should the need arise, this is also where you go to file an Insurance Complaint. Remember, in filing an appeal to a claim for overpayment or a denial, there are time limitations involved.
FCA members (some non-network DCs) have reported calls from ASH representatives or recruiters, indicating, in some instances, that ASH is taking over all lines of business from Florida Blue.
Florida Blue clarified for the FCA, the lines of business ASH maintains for the following Florida Blue health plans and networks:
The recent Florida Blue announcement expanding their chiropractic network management business to the Federal BCBS Plans with American Specialty Health (ASH), has raised many questions and calls have abounded. We reached out to Florida Blue for answers to the most frequently asked questions. Here is what they said:
Last week Florida Blue announced its expansion of American Specialty Health Group, Inc. (ASH) network management for its Preferred Patient Care and Traditional (PPS) networks. Per Florida Blue’s notice, “This includes those in the Federal Employee Program® and members of other Blue Cross and/or Blue Shield plans accessing through Blue Card®.” This has caused a number of member calls from those concerned about the expansion.
Insurance News 