Medicaid

Become a Medicaid healthcare provider for Texas Medicaid, Florida Medicaid, and other state Medicaid insurance programs.
By Marcelina Hardy Medicaid is a federally run program to help needy individuals and families receive quality healthcare. If you recently decided to become a Medicaid healthcare provider so you can serve clients with Medicaid insurance, you will need to take steps to be eligible for Medicaid reimbursement for services. By opening up your business to Medicaid insurance recipients, you will make it possible for needy families and children, seniors over 65 years old, individuals with a disability and pregnant women to receive your services.
 

Each state has its own Medicaid program and the Medicaid eligibility requirements differ state to state. Applying as a Medicaid provider also varies state to state, so applicants need to complete the correct application for their state of business. When setting up your business for Medicaid insurance recipients you will need to:

1. Apply for a Medicaid provider identification number for your business.

2. Establish a Medicaid compliance program to remain in accordance with Medicaid regulations.

3. Submit Medicaid claims for reimbursement of services.

Apply for Medicaid provider identification number

All states require businesses that would like to provide services to Medicaid recipients to apply for an identification number. The application process may take up to 30 days. You will need this number for all paperwork submitted to Medicaid for payment.
Try: For Texas Medicaid providers, an online application is available to you at the Texas Medicaid and Healthcare Partnership. Florida Medicaid providers must print, complete and submit the Medicaid enrollment application form from the Florida Alcohol and Drug Abuse Association. Mississippi Medicaid and Georgia Medicaid providers can apply online at the National Plan and Provider Enumeration System.

Implement a Medicaid compliance program

Medicaid requires detailed records of all services provided to Medicaid insurance recipients. To receive reimbursement for the services you provide, you must have all documentation up to date with Medicaid regulations. These regulations change often so it is imperative to stay on top of any updates.
Try: Learn about starting a Medicaid compliance program in your office at the American Academy of Family Physicians website. Some companies such as The Bureau of National Affairs (BNA) offer services to businesses to help them with their Medicaid compliance program. For up to date information on Medicaid regulations, order the Medicaid Compliance News publication.

Submit Medicaid claim forms for reimbursement of services

To receive reimbursement for services you need to complete Medicaid claim forms and submit them directly to Medicaid. Some states allow you to submit forms electronically, while others still require you to send in the documents.
Try: Find information about how to fill out claims submittal forms and the forms themselves at the Texas Medicaid and Healthcare Partnership website. Georgia Health Partnership has a listing of all of their claim forms and information on how to complete them. Mississippi Envision has a website dedicated to providers with information on billing. Florida businesses can find claim submittal information as well as forms for authorization of services at Florida Medicaid.

• As a Medicaid provider, you may have employees working with your clients that are not Medicaid authorized providers. These employees must be supervised by a Medicaid authorized provider for service reimbursement by Medicaid.