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The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

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For Health Care Professionals

CMS Plan

At the Children's Medical Services (CMS) Plan, we recognize that our providers are the foundation of the health care services we deliver. That is why we recruit only the most talented physicians and health care providers to meet the needs of the special children we serve.

CMS provides a comprehensive system of care for eligible children with special health care needs. We believe in providing accessible, comprehensive, and family-centered care in a medical home setting. In addition, we have intervention, prevention, and other specialty programs that provide community based services in the natural environment and other appropriate settings.

CMS providers are an integral part of a network of local community providers, hospitals, and university medical centers around the state that provide quality care to children who need it most.

Young girl getting a shot

CMS Provider Alerts 

  • CMS: We’re Here to Stay
  • NEW! Summer 2018 Provider Newsletter
  • Provider Payment Delay
  • CMS Plan Provider Satisfaction Surveys
  • Physician Attestation for Clinical Eligibility

The Florida Department of Health’s Children’s Medical Services Plan (CMS Plan) and Specialty Programs is proud to serve Florida’s population of children and youth with special health care needs (CYSHCN). Over the decades, CMS Plan has changed, adapted and grown, always with the goal of providing the best possible care for the children we serve.

The national landscape for health care delivery models continues to change. Florida is well positioned to implement a national model for serving CYSHCN within Medicaid and CHIP and through our Title V initiatives. Rumors have circulated that CMS Plan is “going away” or “closing.” Neither of these is true. While CMS Plan is again in a time of transition, we remain working for the health, safety and quality of life of the children and families we serve.

At this time, there are no immediate changes for providers in our network or for the families we serve. Families do not need to do anything differently, and credentialed providers are still able to see CMS Plan members. Please continue to visit our website for updates (www.CMSPlanFlorida.gov), and rest assured we will contact our members and provider network directly with any changes that will affect them.

CMS Plan SOURCE
(PDF, 810kB)

CMS Plan SOURCE, summer 2018 edition, includes information on the future of the CMS Plan, managing asthma care for CMS Plan members, behavioral health integration in primary care, and more.If you're a CMS Plan provider, you won't want to miss this one.

Please be advised Children’s Medical Services Managed Care Plan (CMS Plan) has experienced a technical difficulty related to claims submitted during the week of 7/08/2018 through 7/14/2018. As a result, providers who are set up to receive payment via Electronic Fund Transfer (EFT) on Friday, July 20, 2018 are expected to receive their payment on Tuesday, July 24, 2018. CMS Plan apologizes in advance for this inconvenience. Should you have any questions, please contact the MED3000 helpdesk at 1-800-664-0146. Please check back here for further updates.

We need your input! Some CMS Plan providers received a survey by mail regarding their satisfaction with being a CMS Plan provider. Your response is very important as it helps shape the experience of and relationship with the CMS Plan for all providers. For your convenience, the Institute for Child Health Policy (ICHP) is mailing a second copy of the survey to your location. CMS Plan is very grateful for your participation.

Effective Tuesday, September 27, 2016, the Florida Department of Health revised Rule 64C-2.002 of the Florida Administrative Code. Changes include adding certain codes to the clinical eligibility screening from and adding additional options for physicians to utilize a medical review panel to determine clinical eligibility. The rule also clarifies that families may request a re-screening to determine clinical eligibility if clinical eligibility was not previously established. Go to our CMS Plan Physician Attestation Process document to learn more.

If you are a treating physician with questions about the attestation form or process, please call 1-855-901-5390.

Become a CMS Plan Provider 

The CMS Plan, and its panel of distinguished providers, has been dedicated to serving children with special healthcare needs and their families since 1929. We thank you for your interest in participating with the plan and invite you to begin the provider application process.

  • Join
  • Join Early Steps or Child Protection Team
  • Provider Relations Liaison

All CMS Plan providers must be credentialed and contracted with the Plan. To begin a new application process, please review the CMS Letter of Interest Requirements document for instructions.

Early Steps - Please contact you Local Early Steps Office in the county for which you would like to provide services.

Child Protection Team - Please contact Marceller Hines at the CPT State Office 1-850-558-9553.

If you need assistance with the credentialing or contracting process, please contact your local provider relations liaison.

Resources 

  • Credentialing Resources
  • Provider Resources & Handbooks
  • CMS Cultural Competency Plan
  • Prior Authorization and Claims Submission

To renew your contract for CMS Plan Title XIX or Title TXXI, please contact the provider relations liaison serving your area.

Cultural competency is one the main ingredients in providing quality health care to our children. It is the way families and providers can come together and talk about health concerns without cultural differences hindering the conversation. Visit the CMS Cultural Competency Plan to learn more.

The CMS Cultural Competency Plan includes provisions for language and communication. This could include language lines, translation services or TTY/TTD services.

According to Title III of the Americans with Disabilities Act (ADA), health care providers are required to provide interpreters for medical visits and other medical-related situations. To learn how health care providers can help meet their patients communication needs, please read the following information regarding ADA requirements.

CMS is contracted with MED3000, a division of McKesson, to serve as the Third Party Administrator to facilitate provider information, client information, service authorizations and claims payment. For more information, please go to MED3000 Enrollment, Authorizations, and Claims.

For questions and technical assistance, providers and CMS staff may contact MED3000 Customer Service at 1-800-664-0146. Families should contact their local CMS Area Office for assistance.

CMS Provider FAQs 

  • Why should I become a CMS provider?
  • How do I become a provider with CMS?
  • How does a provider bill for compensable services to CMS enrollees?
  • How do I submit claims for services rendered?
  • Where can I find a list of CMS approved providers?
At Children's Medical Services, we recognize that our providers are the foundation of the health care services we deliver. As a member of the CMS network, providers have the opportunity to work with the professionals committed to providing the highest quality services to children with special health care needs. Through our partnership with two Integrated Care Systems, Ped-I-Care, and the Community Care Plan (CCP), CMS recruits the most talented physicians and other health care providers to meet the needs children with special health care needs.

Provider enrollment in the CMS plan consists of a two-step process. First, a provider must be credentialed through the CMS Plan. Next, providers must be contracted through one of our two ICS partners. Ped-I-Care serves provider in the panhandle and central Florida counties, and the Community Care Plan (CCP) serves providers in the southern part of Florida.

Once a provider contracts with one of our two ICSs, their information will be registered in the CMS third party administrator data base (Med3000/McKesson). Providers will then have access to the provider portal, E-InfoSource, which gives the provider the ability to:

  • Verify enrollment;
  • Verify approval of prior authorization (when required); and,
  • Review the status of submitted claims.

Approved and registered CMS providers may submit claims electronically through one of the following two electronic Claims Clearinghouses:

  1. Emdeon
  2. Availity

Providers wishing to submit paper claims may do so by mailing claims to the following address:

CMS MMA Specialty Plan Title XIX
P. O. Box 981648
El Paso, TX 79998-1648

You may access a list of CMS approved providers by using our CMS Provider Locator.