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Upon receipt of the APD Initial iBudget Services Listing Letter, the provider must complete the Medicaid Provider Application in the Provider Enrollment Wizard. Please visit the AHCA Website to access the enrollment portal.
See Department of State Form DS-DE 77, incorporated by reference in Rule 1S-2.048, Florida Administrative Code APPLICATION FOR SERVICES, FORM 65G - 4.016A (2024) RULE 65G-4.016, F.A.C.
Using the links below, you can get information on licensing requirements, check the status of an existing application, apply using a printable application, or access the online application system if available for the specific business or profession.
The Florida Medicaid Provider Enrollment Application gathers information related to the applicant’s eligibility to enroll in Florida Medicaid. Providers use this page to complete an enrollment application
Important Instructions. Only persons or entities that render medical, medical-related or waiver-related services to Medicaid recipients through a Medicaid contracted managed care entity (HMP/PSN) may complete this form. This form may not be used to apply as a fee-for-service provider.
22 mar 2024 · Forms, whether paper or electronic, must be completed by all providers of services and suppliers of medical and other health services for enrollment in the Medicare program. Find out what form is applicable for you.
Providers must submit exceptional claims, along with the required Exceptional Claim Form, electronically via the Florida Medicaid Secure Web Portal under the Claims panel.
