How to Become a Florida Medicaid Waiver Provider

Florida Medicaid waivers are offered through the Florida Department of Children and Families and the Social Security Administration. Waivers offer flexible health care by funding services not typically covered through Medicaid, such as psychiatric care or long-term care. Disabled individuals are also eligible for waivers. Providers who would like to offer services to Medicaid waiver recipients will need to be approved by the Florida Agency for Health Care Administration. Submit your application to begin accepting Medicaid waivers.

Instructions

• 1

  Print the Medicaid Provider Enrollment Application. The form is used for persons or entities who want to be paid for rendering Medicaid waiver services. Use only blue or black ink. Visit the resource section of the Florida Alcohol and Drug Abuse Administration website to download the form.

• 2

  Provide your personal information. You will need to include the name of the business or individual, name you are doing business as, tax identification number, physical street address, business phone number, business email and contact person's name and number.

• 3

  Answer questions about the type of provider you are. Enter the provider type code, practice type code, category of service code, specialty code, license information and Medicare number. Check the box if you would like to receive provider handbooks by mail.

• 4

  State how you would like to submit claims. List group provider numbers and effective dates. If the group provider application is pending, check the box "yes" and write down the group name and federal tax identification number.

• 5

  Complete the billing agent agreement. The agreement is your authorization to allow the agent listed to submit claims to Medicare and follow up on your behalf. Provide the billing agent's name, provider number and complete address.

• 6

  Choose whether or not you would like to receive payments electronically. In most cases, funds are transferred into your checking or savings account electronically. If you would like to select this method, provide your account information. If not, complete the electronic funds transfer agreement exception request.

• 7

  Respond to questions about the owner or operator. Include the name, title, relationship to the business, Social Security number, license number and percent owned. You will also be asked background questions, such as whether or not you have been convicted of a felony.

• 8

  Sign the application. You will need to agree to the provider terms.

• 9

  Send your completed application to ACS State Healthcare Provider Enrollment P.O. Box 7070 Tallahassee, FL 32314-7070.