Florida SMMC Billing Updates: Streamlining BA Services for 2025

The Statewide Medicaid Managed Care (SMMC) program in Florida is transitioning to a new phase that integrates Behavior Analysis (BA) services reimbursement into managed care plans, effective February 2025. This change aims to streamline the billing and reimbursement processes for providers and health plans. Office Puzzle, as a leading SaaS platform, is dedicated to supporting providers with this transition by ensuring a seamless setup for billing and claims management.

List of Payers/Health Plans

Below is a summary of the health plans, their websites, phone numbers, and provider portals:

Payer ID: 128FL
Payer Name: AETNA
Plan Name: Aetna Better Health Florida
Website: https://www.aetnabetterhealth.com/
Phone: 786-209-5362
Provider Portal: https://medicaid.aetna.com/MWP/login.fcc
Technology Provider: AVAILITY
Managed By: https://www.bsnnet.com/ 
ERA Enrollment: https://providerpayments.com/Login.aspx

Payer ID: 68069
Payer Name: SUNSHINE
Plan Name: Children’s Medical Services (CMS)
Website: https://www.sunshinehealth.com/
Phone: 866-595-8116
Provider Portal: https://provider.sunshinehealth.com/careconnect/login/oauth2/code/pingcloud&brand=sunshinehealth
Technology Provider: CENTENE
Managed By: Sunshine Health
ERA Enrollment: https://www.payspanhealth.com/nps/login.aspx

Payer ID: 68069
Payer Name: SUNSHINE
Plan Name: Sunshine Health
Website: https://www.sunshinehealth.com/
Phone: 866-595-8116
Provider Portal: https://provider.sunshinehealth.com/careconnect/login/oauth2/code/pingcloud&brand=sunshinehealth
Technology Provider: CENTENE
Managed By: Sunshine Health
ERA Enrollment: https://www.payspanhealth.com/nps/login.aspx

Payer ID: BHOVO
Payer Name: Simply Healthcare
Plan Name: Simply Healthcare (aka Carelon Behavioral Health)
Website: https://www.simplyhealthcareplans.com/florida-home/simply.html
Phone: 954-308-9410
Provider Portal: https://providerportal.carelonbehavioralhealth.com/#/login
Technology Provider: CARELON
Managed By: CARELON
ERA Enrollment: https://www.payspanhealth.com/nps/login.aspx

Payer ID: FLCCR
Payer Name: Florida Community Care
Plan Name: Florida Community Care
Website: https://fcchealthplan.com/
Phone: 786-761-4512
Provider Portal: https://secure.healthx.com/v3app/publicservice/loginv1/login.aspx?bc=16544617-390b-4625-9657-c7b235c09d3c&serviceid=df6f8096-64ea-498a-a657-7c7b407ae072
Technology Provider: MPULSE,(Accquired by ZIPARI, Acquired by HEALTHX)
Managed By: Health Network One
ERA Enrollment: ????

Payer ID: 51062
Payer Name: Molina Healthcare
Plan Name: Molina Healthcare Florida
Website: https://www.molinahealthcare.com/
Phone: 305-317-3152
Provider Portal: https://provider.molinahealthcare.com/
Technology Provider: AVAILITY
Managed By: Molina Healthcare
ERA Enrollment: https://www.availity.com/

Payer ID: 65062
Payer Name: Health Network One
Plan Name: Community Care Plan (CCP)
Website: https://ccpcares.org/
Phone: 954-622-3315
Provider Portal: https://epiclink.mhs.net/planlinkCCP/common/epic_login.asp
Technology Provider: EPIC
ERA Enrollment: ???

Payer ID: 61102
Payer Name: Humana
Plan Name: Humana
Website: https://www.humana.com/medicaid/florida-medicaid/member-support/behavioral-health
Phone: LTC: 803-315-0115 / MMA: 812-987-4031
Provider Portal: https://providerportal.carelonbehavioralhealth.com/#/login
Technology Provider: CARELON
Managed By: CARELON
ERA Enrollment: https://www.availity.com/

Payer ID: 87726
Payer Name: United Healthcare
Plan Name: Optum / United Behavioral Health
Website: https://www.uhc.com/
Phone: LTC: 407-659-7258 / MMA: 407-659-7047
Provider Portal: ????
Technology Provider: CHANGE HEALTHCARE
Managed By: Optum
ERA Enrollment: ???

Checklist

To ensure a seamless transition to the new SMMC billing processes, here are five key steps providers should take:

1. Choose Your Clearinghouse: Evaluate and select the clearinghouse you will use for EDI submissions to ensure compatibility with your payers.
2. Verify Provider Enrollment: Confirm that your practice is enrolled in all necessary health plans to avoid service disruptions.
3. Review ERA Enrollment: Complete ERA (Electronic Remittance Advice) enrollments with your chosen clearinghouse and payers to streamline payment reconciliation.
4. Test Claims Submission: Conduct test claims submissions with your clearinghouse and health plans to identify and resolve any potential issues early.
5. Train Staff: Ensure your billing and administrative staff are familiar with the new processes, payer requirements, and portal navigation.

Clearing Houses

Office Puzzle fully supports EDI 837P (Professional Claim) transactions. This ensures seamless integration and connectivity with any clearinghouse, streamlining the submission and processing of professional healthcare claims.

If you are considering a clearing house these are the ones we typically recommend in Florida.

Get Ready!

Office Puzzle is fully committed to ensuring that all configurations and integrations with health plans are finalized before the February 2025 implementation of the new SMMC program. We will provide another detailed announcement with further guidance and updates as the transition date approaches. Our team is here to support your billing needs, ensuring a seamless and efficient workflow.

Stay tuned for more updates, and do not hesitate to reach out with any questions or concerns!