Florida Medicaid Health Care Alert: September 23, 2021

Final Reminder: Effective 10-1-21 Fee-For-Service Claims will be Denied if Referring, Ordering, Prescribing, and Attending Providers are Not Enrolled

Effective October 1, 2021, any fee-for-service (FFS) claim submitted with a National Provider Identifier (NPI) for a provider not enrolled with Florida Medicaid will be denied, and the provider will not receive reimbursement for services. This includes claims that list a Referring, Ordering, Prescribing, or Attending (ROPA) provider. ROPA providers must be enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b).

Starting October 1, 2021, claims will not pay for any practitioner, group practice, facility, or pharmacy providing services to Florida Medicaid recipients based on a ROPA provider’s referral, order, prescription, or attending services, unless the ROPA provider identified by NPI on the FFS claim is actively enrolled with Florida Medicaid. This includes claims submitted to Florida Medicaid by institutional providers and paid at a calculated reimbursement rate.

Florida Medicaid features a quick and easy, automated ROPA provider enrollment application on the Florida Medicaid Web Portal Enrollment Application Wizard page. 

Please visit the ROPA Provider Enrollment page of the Web Portal for updated information, including the Unenrolled ROPA Provider List, ROPA Providers Frequently Asked Questions and Quick Reference Guides on ROPA provider enrollment and claims billing.

Providers may call the Provider Services Contact Center at 1-800-289-7799, option 7, for billing assistance and option 4 for enrollment assistance.