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It's a New Day in Public Health.

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 

  • Hurricane Irma and Prior Authorization Waiver
  • Free Patient Centered Medical Home Webinar
  • Summer 2017 Florida Medicaid Provider Bulletin Now Available
  • Payment Error Rate Measurement (PERM)
  • Physician Attestation for Clinical Eligibility
  • Continuing Education Opportunities
CMS Plan implemented a policy for continuity and payment of services during and outside of the disaster grace period for Hurricane Irma. This policy is for our Medicaid and KidCare members. Please read the policy and operational detail.

The University of Central Florida (UCF) is offering a Patient Centered Medical Home (PCMH)-Redesigning Primary Care webinar. This is a free, one-hour webinar on PCMH Recognition and its role in improving patient safety and redefining quality outcomes. The presentation will be by one of UCF's NCQA certified PCMH content experts and will provide an overview of NCQA's 2017 requirements to become a PCMH recognized practice.

More information and registration are available on the UCF event page.

The Summer 2017 Florida Medicaid Provider Bulletin is now available on the Florida Medicaid website. The bulletin contains articles related to:

  • AHCA Releasing the Invitation to Negotiate for SMMC Re-Procurement
  • Florida Medicaid Adopted Policies 2016-17
  • Florida Medicaid Policies in Process 2017-18
  • Florida Medicaid Promulgated Fee Schedules
  • New Medicaid Report Providing Critical Data for Quality Improvement
  • EAPG Pricing Implementation
Starting in August 2017, the Payment Error Rate Measurement (PERM) program contractor will contact select Medicaid and CHIP providers. If you are contacted you must comply with the medical records request. For more information you can read AHCA's notice.

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 clincial 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.

Health Care Transition Training

The Health Care Transitions Training Program aims to provide practitioners with an in-depth understanding of the importance of health care transition. It will equip all practice staff with the knowledge and tools they need to facilitate smooth transition from pediatric to adult health care for young Floridians with and without disabilities or special health care needs.

Up to four free continuing education contact hours for Florida physicians, physician assistants, nurses, nurse practitioners, social workers, mental health counselors and allied health professionals are available through the Florida AHEC Network. Get started by visiting http://www.aheceducation.com/.

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
  • Renew (Existing CMS Providers)
  • 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 Intent 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 (850)558-9553

To renew your status as a CMS Plan provider, Please contactour delegated credentialing organization, Community Care Plan, at Credentialingdept@ccpcares.org or 1-866-899-4828. If applicable, you may also need to sign a Provider Contract Renewal with one of our Integrated Care System (ICS) partners.

If you need assistance with the credentialing or contracting process, please contact your local Provider Relations Liaison.

Resources 

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

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 South Community Care Network (SFCCN) 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.